4.6 Article

Clinical outcomes in cirrhotics with variceal or nonvariceal gastrointestinal bleeding: A prospective, multicenter cohort study

Journal

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY
Volume 36, Issue 11, Pages 3219-3223

Publisher

WILEY
DOI: 10.1111/jgh.15601

Keywords

variceal bleeding; nonvariceal bleeding; mortalitycirrhosis

Funding

  1. Italian Association of Hospital Gastroenterologists (AIGO)
  2. Italian Society of Digestive Endoscopy (SIED)
  3. Italian Society of Gastroenterology (SIGE)

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The study found that the overall mortality rate in cirrhotics with UGIB seems to be decreasing, and the value did not differ significantly between variceal and nonvariceal types. Prevention of hepatorenal syndrome and hepatic encephalopathy, along with implementation of antibiotic prophylaxis, could potentially improve survival in these patients.
Background and Aim Upper gastrointestinal bleeding (UGIB) is associated with a distinct mortality in cirrhotics. We evaluated whether the rate of mortality and other outcomes differs between variceal and nonvariceal UGIB. Methods This was a prospective, multicenter, cohort study on UGIB cirrhotics observed in 50 hospitals. Variceal or nonvariceal UGIB were diagnosed at endoscopy. The 6-week mortality rate, need of blood transfusion, intensive care unit (ICU) admission, radiologic or surgical intervention, rebleeding rate, and length of stay in hospital were the main clinical outcomes compared. Data were analyzed at univariate and multivariate analysis, and odds ratio (OR) with their 95% confidence interval (CI) was calculated. Results The study enrolled 706 cirrhotics, including 516 (73%) variceal and 190 (27%) nonvariceal UGIB. There were 78 (11%; 95% CI = 8.7-13.4) deceases, without any difference between variceal (11.0%) and nonvariceal (11.0%) groups. Child-Pugh score C (OR: 6.99; 95% CI = 2.58-18.95), and development of either hepatorenal syndrome (OR: 16.5; 95% CI = 7.02-38.9) or hepatic encephalopathy (OR: 2.38; 95% CI = 1.25-4.5) were independent predictors of mortality. Transfusions and onset of hepatic encephalopathy were significantly more frequent in variceal, whereas ICU admission rate was higher in nonvariceal bleedings. Overall, antibiotic prophylaxis was eventually administered in only 392 (55.5%) patients. Conclusions Data found that the overall mortality rate in cirrhotics with UGIB seems to be reducing and that the value did not differ between variceal and nonvariceal types. Prevention of both hepatorenal syndrome and hepatic encephalopathy and implementation of antibiotic prophylaxis could improve survival in these patients.

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