Recurrent variceal bleeding in cirrhotic patients with acute kidney injury

Abstract

Background: Patients with liver cirrhosis who present with bleeding esophageal varices are at a higher risk of developing acute kidney injury (AKI), which, in turn, has negative impacts and a poor prognosis. In our study, we aimed to determine the association between recurrent esophageal variceal bleeding and the presence of AKI in patients with liver cirrhosis. Methods: Our study included 203 cirrhotic patients, divided into two groups based on the absence or presence of AKI. All patients underwent a comprehensive medical history evaluation, clinical examination, and laboratory investigations. Treatment for all patients included fluid resuscitation, vasopressor agents, and endoscopic management. Both groups were closely monitored to assess the rate of esophageal variceal re-bleeding. Results: Out of the 203 patients, 91 (45%) developed AKI. Several factors, such as low systemic blood pressure, a high volume of blood transfusion, and a high Child-Pugh score, were identified as independent predictors for AKI. Factors such as Child-Pugh scores (p = 0.006), active bleeding observed during endoscopy (p = 0.04), and the occurrence of AKI (p = 0.049) were identified as independent predictors of variceal re-bleeding at both 72 hours and 1 month. Among patients with AKI, the variceal rebleeding rate was 27.5% at 72 hours, 16.5% at 1 month, and 12.1% at 3 months, compared to 9%, 5.4%, and 4.5%, r espectively, in patients without AKI. Within the first 72 hours, the rate of esophageal variceal re-bleeding was higher in patients with a more advanced stage of AKI. Conclusions: The incidence of recurrent esophageal variceal bleeding was significantly higher in patients with liver cirrhosis who developed AKI.