Risk factors for in-hospital mortality in cirrhotic patients with oesophageal variceal bleeding

Introduction 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. Patients and 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. Conclusion 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. Eur J Gastroenterol Hepatol 24:551-557 (C) 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.