Article Text

PDF
Predictors of early re-bleeding and mortality after acute variceal haemorrhage in patients with cirrhosis
  1. K Bambha1,
  2. W R Kim1,
  3. R Pedersen2,
  4. J P Bida2,
  5. W K Kremers2,
  6. P S Kamath1
  1. 1
    Advanced Liver Disease Study Group, Miles and Shirley Fiterman Center for Digestive Diseases, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
  2. 2
    Department of Health Sciences Research and Division of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
  1. Professor P S Kamath, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA; kamath.patrick{at}mayo.edu

Abstract

Background and aims: Risk factors for mortality and re-bleeding following acute variceal haemorrhage (AVH) are incompletely understood. The aim of this study was to determine risk factors for 6-week mortality, and re-bleeding within 5 days in patients with cirrhosis and AVH.

Methods: Kaplan–Meier and Cox proportional hazards regression analyses were used to determine risk factors among 256 patients with AVH entered into a randomised, prospective trial.

Results: Thirty-five patients (14%) died within 6 weeks of AVH; 14 deaths (40%) occurred within 5 days. Only the Model for End-stage Liver Disease (MELD) score and units of packed red blood cells (PRBCs) transfused in the first 24 h were associated with 6-week mortality univariately (HR 1.11, p<0.001; HR 1.22, p<0.001) and bivariately (HR MELD = 1.10, p<0.001; HR per unit of PRBCs transfused = 1.15, p = 0.005). Re-bleeding within 5 days occurred in 37 patients (15%); MELD score (p = 0.01) and a clot on a varix (p = 0.05) predicted re-bleeding. Patients with a MELD score ⩾18; both MELD score ⩾18 and ⩾4 units of PRBCs transfused; both MELD score ⩾18 and active bleeding at index endoscopy; and variceal re-bleeding had increased risk of death 6 weeks post-AVH (HR = 7.4, p<0.001; 11.3, p<0.001; 9.9, p<0.001; 10.2, p<0.001 respectively).

Conclusions: Patients with AVH and MELD score ⩾18, requiring ⩾4 units of PRBCs within the first 24 h or with active bleeding at endoscopy are at increased risk of dying within 6 weeks. MELD score ⩾18 is also a strong predictor of variceal re-bleeding within the first 5 days.

Statistics from Altmetric.com

Footnotes

  • Competing interests: None.

  • Ethics approval: The study protocol was approved by the Mayo Clinic Institutional Review Board.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Digest
    Robin Spiller Magnus Simren