Predictors of the outcome after the first episode of acute variceal bleeding in liver cirrhosis patients

ABSTRACT

To determine the independent predictors of morbidity, mortality and survival after the first episode of acute variceal bleeding in patients with liver cirrhosis. Design: A longitudinal study done on 115 cases. Place and Duration of Study It was conducted in Hayatabad Medical Complex, Peshawar, from January, 1996 to December, 1998 and followed-up till June, 2000. Subjects and One hundred and fifteen cirrhotic patients, 88 men and 27 women, having a mean [' SD] age of 52.4'5.4 years [range 37- 67 years], with first episode of acute variceal bleeding and admitted to the hospital, were studied. All the patients were positive for the virological markers i.e. 73[63.48%] for anti-HCV and 42[36.52%] HBsAg. The mean follow-up was 41 ' 4.3 months with the range of 30 to 54 months. Forty-three [39.81%] patients developed complications during the hospitalization period. These included encephalopathy [n =16], progression of a pre-existent hepatic encephalopathy [n =21] and renal failure [n = 6]. Seven [6.08%] patients died within 48 hours despite therapy. Causes of death included hypovolemic shock in six patients and unsuccessful control of bleeding in one patient. Age, hepatic encephalopathy, renal failure, hepatocellular carcinoma and Child's grade were the independent factors that predicted prognosis at 6 weeks. At the end of observation period, 88[92.63%] patients were alive while 7[7.37%] had died. Conclusions: We conclude that occurrence of a first episode of acute variceal bleeding alters the natural history of liver cirrhosis because it is associated with high morbidity and the frequent development of life-threatening complications especially during the first 6 weeks. Long-term survival in such cases needs to be determined in prolonged studies