Variceal hemorrhage: Analysis of 9987 cases from a Japanese nationwide database.
OBJECTIVE
Gastroesophageal variceal hemorrhage is an important complication of cirrhosis. We investigated the in-hospital mortality and its risk factors after variceal hemorrhage in a large sample population, using a nationwide Japanese database.


METHODS
Data on the patients with variceal hemorrhage were collected for a total of 39 months from a nationwide administrative database covering approximately 1000 hospitals in Japan. The risk factors for fatal outcome after variceal hemorrhage were analyzed with receiver-operator curves (ROC) and univariate and multivariate logistic regression. Comorbidities were assessed with the Charlson Comorbidity Index.


RESULTS
We identified 9987 patients with variceal hemorrhage from a total of 20.3 million inpatients in the database. The median age was 63 years and 68.8% were male. The overall in-hospital mortality was 16.8% (1676 cases). In univariate analysis, Child-Pugh class was the strongest predictor; the area under the ROC of Child-Pugh score for predicting in-hospital mortality was 0.802. In multivariate analysis, increased in-hospital mortality was significantly associated with male sex (vs female: odds ratio [OR] = 1.19, P = 0.01), older age, Child-Pugh class B or C (B vs A: OR = 2.80, P < 0.001; C vs A: OR = 20.1, P < 0.001) and higher Charlson Comorbidity Index (≥6 vs ≤5; OR = 1.29, P < 0.001).


CONCLUSIONS
In spite of recent advances in the treatment of variceal hemorrhage, the in-hospital mortality remained as high as 16%. Poor liver function was the most important predictor, suggesting that liver failure after variceal hemorrhage might have been the cause of death.
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Masaya
M
Sato
Ryosuke
R
Tateishi
Hideo
H
Yasunaga
Hiromasa
H
Horiguchi
Haruhiko
H
Yoshida
Kiyohide
K
Fushimi
Kazuhiko
K
Koike
Child-Pugh score; diagnosis procedure combination; in-hospital mortality; nationwide database; variceal hemorrhage