Predictors of early re-bleeding and mortality after acute variceal haemorrhage

ABSTRACT

Oesophageal variceal haemorrhage is a devastating complication of portal hypertension [PHT]. This study was done to determine the risk factors for re-bleeding within 5 days and mortality up to 6 weeks in patients with cirrhosis and acute variceal haemorrhage [AVH]. The study included 100 patients presenting with haematemesis and/or melena due to bleeding varices. All patients were subjected to full clinical assessment, routine laboratory investigations, calculation of the Child-Turcotte-Pugh [CTP] and model for end stage liver disease [MELD] scores, abdominal ultrasound and emergency upper gastrointestinal endoscopy. The patients were followed up since admission and up to 6 weeks for the occurrence of rebleeding [in the first 5 days] and mortality [up to 6 weeks] after the acute attack. The patients were grouped into three groups Group I patients who survived more than 6 weeks following endoscopic management and did not rebleed during this period [75 patients]. Group II patients who died within 6 weeks of AVH [10 patients]. Group III patients who rebled or died within 5 days of AVH [15 patients]. The mean MELD score was significantly higher in group II [18.29 +/- 0.66] and group III [18.73 +/- 0.89] as compared to group I [12.8 +/- 2.1] [p = 0.001]. Active bleeding at time of endoscopy was present in 8% of group I, 70% of group II and 53.3% of group III and the difference was statistically significant [p = 0.003], while white nipple sign was present in 10.6% of group I, 90% of group II and 73.3% of group III and the difference was statistically significant [p = 0.05]. In conclusion high MELD score [>18], presence of active bleeding or white nipple sign at time of endoscopy are significant predictors for early rebleeding and mortality after AVH