Effect of gender on mortality and causes of death in cirrhotic patients with gastroesophageal varices. A retrospective study in Norway

Abstract

Background & aimsThe prognostic role of gender in patients with liver cirrhosis is not fully understood. Our primary aim was to assess how gender affects cumulative incidence and risk of death without liver transplantation (LT) in cirrhotic patients with gastroesophageal varices. Secondary aims were to assess the relationship between gender and cause specific death, risk of variceal bleeding and incidence rates of gastroesophageal varices in patients with cirrhosis. MethodsAll new patients with gastroesophageal varices due to liver cirrhosis at Oslo University Hospital between 2006 and May 2016 were identified. Clinical data were retrieved retrospectively from hospital files. Causes of death were classified according to a specified protocol in cases of in-hospital-death, otherwise by data from the Norwegian Death Registry. Competing risk analyses were used to calculate cumulative incidences and risks of i) all-cause death, ii) cause-specific death and iii) variceal bleeding or re-bleeding. ResultsCumulative one-and five years incidence of death without LT in 266 included patients were 28% and 51%, respectively. In univariate analysis, risk of death was positively associated with age, Child Pugh class, alcoholic liver disease and presentation with variceal bleeding, and negatively associated with female sex. In a multivariate model, risk of death without LT was associated with female sex ]), age (SHR 1.05 [1.04-1.07] per year), Child Pugh class B (SHR 1.54 [1.03-2.32]) and Child Pugh class C (SHR 4.29 [2.57-7.17]). Variceal bleeding caused 27% of deaths. Adjusting for age and Child Pugh score, a trend towards reduced risk of death due to variceal bleeding was seen in women (SHR 0.53; PLOS ONE PLOS ONE | https://doi.

Cirrhosis: Therapeutic Aspects and Outcome for Hospitalized Patients in Burkina Faso

“…The in-hospital case fatality rate was high at 32.3% comparable to the results of previous studies in the same setting which were between 28.5% and 33.3% [12] [13]. The causes of this high mortality would mainly be the gastrointestinal bleeding and hepatic encephalopathy [19] [26] [28].…”

“…The sex ratio of 2.7 found in our work once again corroborated this observation. The male gender would be associated with a greater mortality from bleeding caused by ruptured esophageal varices [19]. Regarding the causes of cirrhosis, the in-hospital proportions of patients testing positive for HBsAg and anti-VHCAb was 76.5% and 14.6%, respectively, as in many other studies [11] [13].…”

“…Another serious complication of cirrhosis is the gastrointestinal bleeding from ruptured oesophageal varices. Its incidence is estimated at between 12% and 15% per year with a mortality rate at up to 20% [19] [29]. Different therapeutic procedures are used including drug treatments (non-cardio selective beta-blockers, or isosorbide mononitrate or both), endoscopic interventions (ligation of oesophageal varices, or sclerotherapy), blood shunts (total shunt, transjugular portosystemic or distal splenorenal shunt).…”

Decline in acute upper gastrointestinal bleeding during COVID-19 pandemic after initiation of lockdown in Austria

“…Alcoholic liver disease is also a leading cause of liver cirrhosis in Austria, and lockdown might result in increased consumption of alcohol. Importantly, alcohol consumption is a well-known risk factor for variceal bleeding 14 .…”

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“…During the study period until December 2019, 77 (49%) of patients died, 53% due to the complications of the underlying liver cirrhosis. Interestingly only 2/77 (2.6%) died of variceal bleeding which is much lower than in other recent cirrhotic cohorts (16,(36)(37)(38). Patients with alcoholic etiology had a better prognosis than patients with a non-alcoholic etiology.…”