Mortality and rebleeding following variceal haemorrhage in liver cirrhosis and periportal fibrosis

Abstract

AIMTo investigate mortality and rebleeding rate and identify associated risk factors at 6 wk and 5 d following acute variceal haemorrhage in patients with liver cirrhosis and schistosomal periportal fibrosis.METHODSThis is a prospective study conducted during the period from March to December 2014. Patients with portal hypertension presenting with acute variceal haemorrhage secondary to either liver cirrhosis (group A) or schistosomal periportal fibroses (group B) presenting within 24 h of the onset of the bleeding were enrolled in the study and followed for a period of 6 wk. Analysis of data was done by Microsoft Excel and comparison between groups was done by Statistical Package of Social Sciences version 20 to calculate means and find the levels of statistical differences and define the mortality rates, the P value of < 0.05 was considered to be significant.RESULTSA total of 94 patients were enrolled in the study. Thirty-two patients (34%) had liver cirrhosis (group A) and 62 (66%) patients had periportal fibrosis (group B). Mortality: The 6-wk and 5-d mortality were 53% and 16% respectively in group A compared to 10% and 0% in group B (P value < 0.000 and < 0.004). In group A; a Child-Turcotte-Pugh class C and rebleeding within 5 d were significantly associated with 5-d mortality (P value < 0.029 and < 0.049 respectively) and Child- Turcotte-Pugh class C was also a significant risk factor for 6-wk mortality (P value < 0.018). In group B; mortality was significantly associated with rebleeding within the 6-wk follow-up period and requirement for blood transfusion on admission (P value < 0.005 and < 0.049). Rebleeding: The 6-wk and 5-d rebleeding rate in group A were 56% and 25% respectively compared to 32% and 3% in group B (P value < 0.015 and < 0.002). Clinical presentation with encephalopathy was a significant risk factor for 5 d rebleeding in group A (P value < 0.005) while grade III periportal fibrosis and requirement for blood transfusion on admission were significant risk factors for 6-wk rebleeding in group B (P value < 0.004 and < 0.02).CONCLUSIONThe 6-wk and 5-d mortality and rebleeding rate were significantly higher in patients with liver cirrhosis compared to patients with schistosomal periportal fibrosis.

Praziquantel and Upper Gastrointestinal Bleeding in Hepatic Schistosomiasis: A Quasi-Experimental Study

“…We identified advanced periportal fibrosis, large varices, ascites, and jaundice as independent predictors of UGIB. Others have reported similar findings [14,23,[33][34][35]. Our results also showed individuals with a close family member with HS were more likely to experience more episodes of UGIB.…”

Safety of performing transoesophageal echocardiography in patients with oesophageal varices

“…The presence of oesophageal varices (EV) is common in patients with hepatic cirrhosis, and is estimated to occur in 60% of patients with decompensated liver disease and 30% of patients with compensated liver disease 1 2. Bleeding EV is considered a serious complication with a high mortality rate that ranges from 30% to 50% in the first 6 weeks following an initial bleed 3. The risk of variceal bleeding is directly proportional to the size of the varices and the severity of liver dysfunction 4…”

Schistosomiasis, Upper Gastrointestinal Bleeding, and Health Related Quality of Life Measurements in Rural Africa

“…In chronic schistosomiasis, recurrent variceal hemorrhage usually occurs within 6 weeks of hospitalization after the initial episode of acute variceal hemorrhage and is associated with a high risk of death. It is shown one out of ten persons with UGIB due to chronic schistosomiasis will die within 6 weeks of acute variceal hemorrhage and 3 out of 10 persons will re-bleed over the same period [6]. Early diagnosis and appropriate preventive therapy are therefore recommended for those who experience variceal UGIB due to schistosomiasis.…”