title: Epistaxis in end stage liver disease masquerading as severe upper gastrointestinal hemorrhage.
abstract: OBJECTIVE
  To describe the prevalence, diagnosis, treatment, and outcomes of end stage liver disease (ESLD) patients with severe epistaxis thought to be severe upper gastrointestinal hemorrhage (UGIH).
  
  
  METHODS
  This observational single center study included all consecutive patients with ESLD and epistaxis identified from consecutive subjects hospitalized with suspected UGIH and prospectively enrolled in our databases of severe UGIH between 1998 and 2011.
  
  
  RESULTS
  A total of 1249 patients were registered for severe UGIH in the data basis, 461 (36.9%) were cirrhotics. Epistaxis rather than UGIH was the bleeding source in 20 patients. All patients had severe coagulopathy. Epistaxis was initially controlled in all cases. Fifteen (75%) subjects required posterior nasal packing and 2 (10%) embolization in addition to correction of coagulopathy. Five (25%) patients died in the hospital, 12 (60%) received orthotopic liver transplantation (OLT), and 3 (15%) were discharged without OLT. The mortality rate was 63% in patients without OLT.
  
  
  CONCLUSIONS
  Severe epistaxis in patients with ESLD is (1) a diagnosis of exclusion that requires upper endoscopy to exclude severe UGIH; and (2) associated with a high mortality rate in patients not receiving OLT.
authors.affiliation: Marine Camus, Dennis M Jensen, Gordon V Ohning, Thomas O Kovacs, Rome Jutabha, Kevin A Ghassemi, Gustavo A Machicado, Gareth S Dulai, CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90095, United States.
authors.forename: Marine
authors.initials: M
authors.lastname: Camus
authors.affiliation: Marine Camus, Dennis M Jensen, Gordon V Ohning, Thomas O Kovacs, Rome Jutabha, Kevin A Ghassemi, Gustavo A Machicado, Gareth S Dulai, CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90095, United States.
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Jensen
authors.affiliation: Marine Camus, Dennis M Jensen, Gordon V Ohning, Thomas O Kovacs, Rome Jutabha, Kevin A Ghassemi, Gustavo A Machicado, Gareth S Dulai, CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90095, United States.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Matthews
authors.affiliation: Marine Camus, Dennis M Jensen, Gordon V Ohning, Thomas O Kovacs, Rome Jutabha, Kevin A Ghassemi, Gustavo A Machicado, Gareth S Dulai, CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90095, United States.
authors.forename: Gordon V
authors.initials: GV
authors.lastname: Ohning
authors.affiliation: Marine Camus, Dennis M Jensen, Gordon V Ohning, Thomas O Kovacs, Rome Jutabha, Kevin A Ghassemi, Gustavo A Machicado, Gareth S Dulai, CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90095, United States.
authors.forename: Thomas O
authors.initials: TO
authors.lastname: Kovacs
authors.affiliation: Marine Camus, Dennis M Jensen, Gordon V Ohning, Thomas O Kovacs, Rome Jutabha, Kevin A Ghassemi, Gustavo A Machicado, Gareth S Dulai, CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90095, United States.
authors.forename: Rome
authors.initials: R
authors.lastname: Jutabha
authors.affiliation: Marine Camus, Dennis M Jensen, Gordon V Ohning, Thomas O Kovacs, Rome Jutabha, Kevin A Ghassemi, Gustavo A Machicado, Gareth S Dulai, CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90095, United States.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Ghassemi
authors.affiliation: Marine Camus, Dennis M Jensen, Gordon V Ohning, Thomas O Kovacs, Rome Jutabha, Kevin A Ghassemi, Gustavo A Machicado, Gareth S Dulai, CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90095, United States.
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Machicado
authors.affiliation: Marine Camus, Dennis M Jensen, Gordon V Ohning, Thomas O Kovacs, Rome Jutabha, Kevin A Ghassemi, Gustavo A Machicado, Gareth S Dulai, CURE Hemostasis Research Group, CURE Digestive Diseases Research Center, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90095, United States.
authors.forename: Gareth S
authors.initials: GS
authors.lastname: Dulai
mesh_terms: D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D016208:Databases, Factual; D003937:Diagnosis, Differential; D058625:End Stage Liver Disease / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D004844:Epistaxis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D006489:Hemostatic Techniques; D017052:Hospital Mortality; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D015995:Prevalence; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Cirrhosis; Coagulopathy; Digestive bleeding; End stage liver disease; Epistaxis; Liver transplantation; Nasal packing; Nasogastric tube; Upper gastrointestinal bleeding