Factors related to early mortality in cirrhotic patients bleeding from varices and treated by urgent sclerotherapy.

Abstract

Variceal haemorrhage in cirrhotic patients carries a high early mortality even when balloon tamponade or emergency sclerotherapy are applied. The aim of this study to identify patients dying within six weeks of their first variceal haemorrhage. One hundred and twenty one patients with parenchymal cirrhosis presenting with the first variceal bleeding episode between June 1983 and December 1988 were studied. Nineteen patients were excluded for various reasons. Emergency sclerotherapy was carried out in cases of active bleeding or where there were endoscopic signs of recent bleeding, and then regularly repeated afterwards. Of the 24 variables studied and included in a multivariate analysis using a logistic regression model, three had an independent prognostic value: encephalopathy, prothrombin time, and the number of blood units transfused within the 72 hours of time zero. The subsequent regression equation was able to predict 89% of the patients who will die and 97% of the patients who will still be alive six weeks after their first variceal haemorrhage treated by sclerotherapy. Pugh score was less discriminatory than these last three variables in terms of accuracy of adjustment, goodness of fit to the model, receiver operating characteristic curves, and percentage correct prediction. To measure the accuracy of the prediction rule, our model was applied to another series of 28 cirrhotic patients admitted with their first variceal bleeding during the next period (January 1989 to May 1990). Death and survival were correctly predicted in respectively 82% and 94% ofthe cases. The use ofthis score is recommended for the selection of patients with high early mortality after variceal bleeding despite sclerotherapy, and for the design of new therapeutic trials.

A comparison of Child-Pugh, APACHE II and APACHE III scoring systems in predicting hospital mortality of patients with liver cirrhosis

“…Numerous attempts have been made to develop a reliable prognostic survival model for cirrhosis. The target population of the different scoring systems in the literature covers patients with liver cirrhosis [1-7], alcoholic liver disease [8,9], variceal bleeding [10-17], and upper gastrointestinal bleeding including variceal bleeding [18-20]. The Child-Turcotte classification [1] and its subsequent modification by Pugh [10] are old empiric methods to assess hepatocellular functional reserve in candidates for portosystemic shunting.…”

Predictors of early re-bleeding and mortality after acute variceal haemorrhage in patients with cirrhosis

“…Several risk factors have been identified that are associated with mortality risk for an episode of AVH, including active bleeding at initial endoscopy, haematocrit level, aminotransferase levels, hepatic venous pressure gradient (HVPG), presence of portal vein thrombosis, alcoholic liver disease, serum bilirubin and albumin levels, hepatic encephalopathy, hepatocellular carcinoma (HCC) and the Child–Turcotte–Pugh (CTP) score 4 9. Many of these data have been derived from retrospective studies when mortality rates following an episode of variceal bleeding were up to 50%, from relatively small numbers of patients, or from patient groups in whom therapy was not according to a standard protocol, including variability in the use of antibiotics 4 10 11…”

Predictors of Intra-Hospital Mortality in Patients with Cirrhosis

“…Many studies have focused on the search for predictors of mortality in cirrhotic patients, and their use to develop a reliable model of survival. In these studies, the study populations were cirrhotic patients [1]- [5], patients with alcoholic cirrhosis [6] [7], and cirrhotic patients after an episode of variceal bleeding [8]- [12]. The Child-Turcott score [1] and its subsequent modifications by Pugh [8] are old empirical methods used to assess the degree of liver failure in candidate patients for porto-systemic shunt.…”