Predictors of mortality in patients with acute upper gastrointestinal hemorrhage who underwent endoscopy and confirmed to have variceal hemorrhage

Abstract

Background: Variceal hemorrhage (VH) is a major complication of chronic liver disease. Several factors have been validated for the prediction of the outcome of an acute VH. The clinical risk characteristics reported in developed countries may be different from developing countries.

Aim: The aim of this study was to determine the predictors of mortality in patients admitted to our hospital with acute upper gastrointestinal (UGI) hemorrhage who underwent endoscopy and confirmed to have VH.

Patients and methods: This was a cross sectional hospital based study performed over a seven-year period between January 2006 and January 2013.

Results: A total of 224 patients were analyzed. Nineteen patients (8%) died within the first two weeks of their hospital admission. Eighteen variables were studied and included in a multivariate analysis using a logistic regression model. Five variables were predictors of death. Hemodynamic instability at admission (AOR= 5.5, 95% CI= 22.3 + 1.4, P = 0.017), Child class C (AOR =5.9, 95% CI =24 + 1.5, P =0.013), blood in upper gastrointestinal (UGI) tract at the index endoscopy (AOR =12.8, 95% CI= 126.5+ 1.3, P = 0.03), rebleeding within five days of endoscopy (AOR =25.4, 95% CI =109.2 + 5.9, P = 0.000), and in-hospital  complications (AOR= 23.4, 95% CI= 122.5+ 4.5, P = 0.000) were independent predictors of mortality after the acute VH episode.

Conclusion: Patients with acute VH and hemodynamic instability at admission, Child class C, blood in UGI tract at the index endoscopy, rebleeding within five days of endoscopy and in-hospital complications are at an increased risk of mortality after the acute VH episode. Rebleeding within five days of endoscopy and in-hospital complications are the most significant independent predictors of mortality.