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

Background and study aims: 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). Patients and methods: 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. Results: 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). Results: 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. (C) 2013 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved.