Factors predicting in-hospital mortality in patients with cirrhosis hospitalized with gastro-esophageal variceal hemorrhage.
OBJECTIVE
To identify factors at the time of admission that predict in-hospital mortality in patients with gastro-esophageal variceal hemorrhage.


METHODS
Case records of patients admitted with gastro-esophageal variceal hemorrhage between January 1998 and October 2003 were retrospectively analyzed. Relevant clinical and laboratory parameters and their relationship to mortality, were studied. Clinical parameters assessed included Child-Pugh class, ascites, portosystemic encephalopathy (PSE) and occurrence of rebleed within 24 hours of esophago-gastroduodenoscopy. The laboratory parameters assessed were: hemoglobin, prothrombin time, serum bilirubin, creatinine and albumin.


RESULTS
Of the 343 patients admitted during the study period, 30 (8.7%) died in hospital. Serum bilirubin (2.4 versus 1.6 mg/dL) and serum creatinine (2.1 vs 1.1 mg/dL) levels were higher among non-survivors than among survivors. Non-survivors were also more likely to suffer from PSE (53%) than survivors (17%), while re-bleeding within 24 hours of endoscopy occurred in 40% and 5% of these groups, respectively. On multivariate analysis, serum creatinine > 1.5 mg/dL at the time of admission (p < 0.001), serum bilirubin > 3 mg/dL (p < 0.001), presence of PSE (p = 0.003) and rebleed within 24 hours of endoscopy (p < 0.001) were significant predictors of mortality.


CONCLUSIONS
Serum creatinine and bilirubin levels, presence of PSE and re-bleeding within 24 hours of initial endoscopy are independent predictors of mortality in patients with gastro-esophageal variceal bleeding.
Ismail
Faisal W
FW
Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan.
Mumtaz
Khalid
K
Shah
Hasnain A
HA
Hamid
Saeed
S
Abbas
Zaigham
Z
Abid
Shahab
S
Anis
Kashif
K
Ahmad
Ashfaq
A
Jafri
Wasim
W
D001780:Blood Coagulation Tests; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000401:mortality*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000401:mortality*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012307:Risk Factors