Objective Bleeding gastroesophageal varices are a cause of high mortality among cirrhotic patients. Aim The aim of this study was to study prognostic factors for mortality in cirrhosis associated with variceal bleeding. Patients and Methods This prospective study was conducted on 100 cirrhotic patients admitted to the Tanta University Hospital with an acute first variceal bleeding episode. Baseline clinical, laboratory, and endoscopic findings were recorded at presentation. Results During the first 6 weeks 15 patients died, 3 following the initial bleed and 12 after an early rebleed. At 6 months, a further 21 patients had died. Statistical analysis utilizing the baseline data revealed that high early death rate was associated with number of blood units transfused, lower systolic blood pressure, thrombocytopenia, increased serum creatinine and international normalized ratio (INR). High MELD, AIMS56, acute physiology and chronic health evaluation II (APACHE II) and ROCKall scores were risk factors for mortality. Risk factors for early rebleeding included presence of diabetes mellitus, leucocytosis, high Child score, model for end-stage liver disease (MELD), AIMS56, and sepsis-associated organ failure assessment (SOFA) scores. A high Child score, presence of ascites, and associations such as hepatic encephalopathy and spontaneous bacterial peritonitis, leucocytosis, elevated alanine transaminase, aspartate transaminase, bilirubin, INR, and creatinine as well as low albumin were associated with decreased survival. Conclusion High MELD, AIMS56, APACHE II, and ROCKall scores were risk factors for mortality after acute variceal bleeding. High death rate during the first 6 weeks is associated with anemia, hypotension, thrombocytopenia, increased serum creatinine, and INR. Decreased survival at 6 months is associated with increased Child score, presence of ascites and associations such as hepatic encephalopathy and spontaneous bacterial peritonitis.
Background & Aims: Bleeding gastroesophageal varices are a cause of high mortality among cirrhotic patients. We aimed to investigate late mortality predictors and prognostic models using easily verified factors at admission in cirrhotic patients with acute variceal bleeding (AVB). Methods: Between January 2020 and June 2020, 142 patients with AVB from Tanta university hospital were included. Investigating multiple prognostic models was done using multiple logistic regression after identifying significant predictors of 6 months' mortality. Mortality prediction accuracy was assessed with area under the receiver operating characteristic (AUROC) curve. Results: The 6 months’ overall mortality rate was 31% (44 patients had died). AIMS56, Child-Turcotte-Pugh (CTP) grade C and MELD scores were significantly higher among non survivors (p<0.001) while Platelet-albumin-bilirubin (PALBI) was significantly more negative among survivors (P=0.001). Hepatocellular carcinoma was not significantly related to the mortality (p =0.364). Univariate analysis showed that high CTP, MELD, AIMS65 and PALBI scores were predictors of mortality and associated with decreased survival with high sensitivity and low specificity; while multivariate analysis showed that only AIMS56 was independently associated with mortality (p 0.004). Conclusion: CTP, MELD, AIMS65 and PALBI scores are simple, bed side risk scores that can be used for the prediction of 6 months’ mortality after AVB in cirrhotic patients with high sensitivities and lower specificities.
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