Evaluation of INR Elevation in Cirrhotic Patients as a Risk Factor for Esophageal Variceal Bleeding

Abstract

Background and study aim: Bleeding esophageal varices is a life threatening complication in cirrhotic patients. So, studying risk factors for bleeding esophageal varices is a must. Because of complexity and dynamic nature of coagulation process in cirrhotic patients, INR is considered a false method to measure bleeding risk in such patients. This study aims at evaluating INR elevation in cirrhotic patients as a risk factor for esophageal variceal bleeding. Patients and Methods: This case control study was conducted at the Intensive Care Unit and inpatient wards of Tropical Medicine Department affiliated to Zagazig University Hospitals in the period from April 2016 to January 2017. According to inclusion and exclusion criteria, 202 patients with liver cirrhosis and esophageal varices were included in this study. Cases were cirrhotic patients admitted to the hospital due to first attack of actively bleeding esophageal varices. Controls were cirrhotic patients without bleeding esophageal varices admitted with ascites, SBP or hepatic encephalopathy. Results: Median admission INR was 1.3 in bleeders compared to 1.9 in non-bleeders with a highly significant statistical difference between both groups. Conclusion: Study concluded that INR elevation reflects the degree of liver dysfunction not the risk of bleeding from esophageal varices.