Introduction Acute variceal haemorrhage (AVH) is associated with significant mortality risk. We conducted a prospective audit of patients admitted with AVH in the Northwest (NW) of England to examine our clinical practice and patient outcomes.
Methods We undertook a prospective multi-centre audit of AVH related admissions to 12 NW hospitals between November 2011 to April 2012. Data on patient characteristics, management and outcomes were collated by reviewing hospital records. Adherence with Baveno V consensus guidelines was examined. The findings were compared with 2007 UK Comparative Audit of Upper Gastrointestinal Bleeding (AUGIB).1 Data analysis was performed by considering the frequency distribution of variables and their association with in-hospital mortality and length of stay.
Results 102 patients (median age 53 years, 67% male) details were available. More than half the patients were admitted out-of-hours (57%) and 28% were admitted on weekends. The median time to gastroscopy was 1 (IQR 0–1.5) day. Majority of patients were managed by a gastroenterologist (88%) and received Terlipressin (75%) and antibiotics (64%). The median length of stay was 8 (IQR 5–14) days and 13% of patients died during their hospitalisation. The rate of failure to control bleeding within 120 hours was 17% and 19% of the patients had a re-bleed. In total, 5% had Sengstaken tube insertion and 7% had emergency TIPSS insertion. Age over 65 years (p = 0.008) and admission out-of-hours (p = 0.03) was associated with a higher mortality. Failure to control bleeding within 120 hours (p < 0.001) and re-bleeding (p = 0.007) were also associated with increased mortality. Significantly less mortality was observed in patients that were managed by a gastroenterologist (42% versus 9%, p = 0.002). Encephalopathy was associated with a significantly prolonged length of stay (18.2 versus 10 days, p = 0.0002) as was admission to HDU/ICU (19.6 versus 9.2 days, p = 0.0001). There was no difference in length of stay based on admission out-of-hours, inpatient management by gastroenterologist, use of terlipressin, use of antibiotics and re-bleeding.
Conclusion The mortality rate, length of hospital stay, use of terlipressin, prophylactic antibiotics, and therapeutic interventions at endoscopy to control AVH appeared to be better than 2007 UK AUGIB report. However, timeliness of endoscopic intervention and adherence to standard guidelines remained deficient in parts across the region. The development of a NW England regional AVH care bundle consisting of an agreed protocol and pathway for emergency TIPSS may help improve patient outcomes.
Reference 1 Hearnshaw SA, et al. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut. 2011;60(10):1327–35.
Disclosure of Interest None Declared
Statistics from Altmetric.com
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.