title: Predictors of In-Hospital Mortality in patients with hepatocellular carcinoma and Acute Variceal bleeding.
abstract: BACKGROUND
  Detection of hepatocellular carcinoma (HCC) in cirrhotic patients remains a serious, unsolved problem, and the risk factors for acute variceal bleeding (AVB) in HCC patients remain unclear. This study aimed to determine the in-hospital mortality (IHM) and factors influencing the clinical outcomes of AVB in patients with liver cirrhosis and HCC.
  
  
  METHODS
  This was a retrospective, non-randomized, clinical study that was conducted in 2014. The study was conducted on 70 patients with liver cirrhosis and HCC presenting by acute upper gastrointestinal bleeding (AUGIH). All patients were examined endoscopically within 24 hours from presentation and bleeding varices accounted for AUGIH. Full medical history, clinical examination, and laboratory and radiologic data were collected from admission charts, and hospital medical records were statistically analyzed with SSPS version 22.
  
  
  RESULTS
  Thirty-two patients (45.7%) survived and 38 died (54.3%). Survivors are more likely to be Child-Pugh class A or B, and the non-survivors were class C. The Model for End-Stage Liver Disease (MELD) was highly predictive of IHM at an optimized cut-off value of ≥ 12.9. Higher esophageal varices grades and presence of active bleeding on index endoscopy were significant (p < 0.01) in the non-survivors compared to survivors. Complications of liver cirrhosis and associated major comorbidity were significantly higher (p < 0.01) in the non-survivors than the survivors. Univariate logistic regression analysis identified higher Grade Esophageal Varices and number of transfused packed red blood cells units as two independent predictors of IHM.
  
  
  CONCLUSIONS
  IHM was particularly high (54.3%) among HCC patients with AVB who had MELD score > 12.9, higher grade Esophageal Varices, active bleeding on index endoscopy, more increased needs for blood transfusion, longer hospital stay, decompensated liver disease with major comorbidity.
authors.affiliation: Hepatogastroenterology department, Department of Environment Research, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Moataz
authors.initials: M
authors.lastname: Hassanien
authors.affiliation: Hepatogastroenterology department, Department of Environment Research, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Mohamed Darwish
authors.initials: MD
authors.lastname: El-Talkawy
authors.affiliation: Hepatogastroenterology department, Department of Environment Research, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Maged
authors.initials: M
authors.lastname: El-Ghannam
authors.affiliation: Hepatogastroenterology department, Department of Environment Research, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: El Ray
authors.affiliation: Hepatogastroenterology department, Department of Environment Research, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Abdel Aziz
authors.initials: AA
authors.lastname: Ali
authors.affiliation: Biostatistics and Demography, Medical Statistician, Department of Environment Research, Theodor Bilharz Research Institute, Giza, Egypt.
authors.forename: Hoda Abu
authors.initials: HA
authors.lastname: Taleb
keywords: MELD score; acute upper gastrointestinal bleeding; complications of liver cirrhosis; hepatocellular carcinoma; prognosis