title: Risk factors for in-hospital mortality in cirrhotic patients with oesophageal variceal bleeding.
abstract: BACKGROUND
  Oesophageal variceal bleeding (OVB) is a high mortality rate complication in patients with cirrhosis. The aim of this study was to assess the risk factors for in-hospital mortality (IHM) in cirrhotic patients with OVB.
  
  
  METHODS
  The study cohort included 102 patients (average age, 55.4 ± 12.6 years, 71.6% men) consecutively admitted to our hospital with OVB. All the patients underwent upper endoscopy within 12 h and octeotride or terlipressin therapy was started at admission and continued for 5 days. To calculate Model for End-Stage Liver Disease (MELD) and Child-Turcotte-Pugh scores, laboratory test data from blood samples taken within 6 h of admission were used.
  
  
  RESULTS
  The IHM was 18.6% [19 patients; confidence interval (95% CI): 11.1-26.2%]. In the univariate analysis, transfusion with 2 or more units of packed red blood cells [PRBC; P=0.038; odds ratio (OR)=7.8; 95% CI: 1.2-61.3], platelets of 100/ml or less (P=0.014; OR=3.6; 95% CI: 1.2-10.3), Child-Turcotte-Pugh score of 10 or more (P=0.002; OR=4.0; 95% CI: 1.2-13.2) and MELD of 18 or more (P=0.044; OR=2.8; 95% CI: 1.1-8.1) were associated with IHM. In the multivariate analysis, transfusion with 2 or more units of PRBC (P=0.076; OR=6.7; 95% CI: 0.82-54.8), platelets of 100/ml or less (P=0.031; OR=3.4; 95% CI: 1.1-10.6) and MELD of 18 or more (P=0.048; OR=3.2; 95% CI: 1.02-10.1) remained independently associated with IHM. Applying a receiver operating characteristic analysis, the area under the curve derived from the multivariate analysis model was 0.76 (95% CI: 0.64-0.88) for IHM.
  
  
  CONCLUSIONS
  Cirrhotic patients with OVB and MELD of 18 or more, platelets of 100/ml or less and requiring transfusion of 2 or more units of PRBC were at an increased risk of IHM. Overall, the logistic regression model correctly predicts 82.2% of IHM patients.
authors.affiliation: Department of Gastroenterology, S Sebastião Hospital, Santa Maria Feira, Portugal. rute.cerqueira@chedv.min-saude.pt
authors.forename: Rute Maria
authors.initials: RM
authors.lastname: Cerqueira
authors.forename: Luis
authors.initials: L
authors.lastname: Andrade
authors.forename: Manuel Rodriguez
authors.initials: MR
authors.lastname: Correia
authors.forename: Carolina Duesca
authors.initials: CD
authors.lastname: Fernandes
authors.forename: Maria Conceição
authors.initials: MC
authors.lastname: Manso
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017707:Erythrocyte Transfusion; D004932:Esophageal and Gastric Varices / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000401:mortality*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality*; D008236:Lypressin / Q000031:analogs & derivatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use; D010976:Platelet Count; D011174:Portugal / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index; D000077585:Terlipressin; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D005765:Gastrointestinal Agents; D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin; D015282:Octreotide