Purpose: Predictors of early mortality are well described for patients who present with acute bleeding from peptic ulcer disease. These predictors are less described for patients who present with acute bleeding from esophageal varices (EV).
Methods: In order to determine the predictors of 30-day mortality in patients with acute bleeding from EV, we performed a retrospective cohort study in a major health system (Henry Ford Health System, Detroit, Michigan). All patients who presented with acute bleeding from EV were included. Data including age, gender, ethnicity, etiology of liver cirrhosis, prior complications of liver cirrhosis (ascites, encephalopathy, prior history of EV, prior history of endoscopic band ligation, and presence of hepatocellular carcinoma), use of B blockers prior to admission, numbers of bands applied during initial endoscopy, MELD score on presentation and the number of blood products transfused during the patients' hospital stay was obtained and analyzed.
Results: We identified 109 patients who presented with an acute episode of bleeding from EV. Eight patients died within 30 days of presentation. The MELD score on admission was found to be a predictor of 30-day mortality on univariate analysis (26.0 ± 5.3 vs. 15.0 ± 5.0) (p<0.001). Patients with a MELD score of 21 or more were found to have a higher 30-day mortality than patients with a MELD score less than 21 (41.2% vs. 1.1%) (p<0.001). Patients who received a larger number of red blood cells (RBCs), fresh frozen plasma (FFPs) or platelets (PLTs) during their hospital stay were also found to have a higher 30-day mortality. This was particularly seen in patients who received either 10 or more units of RBCs vs. less than 10 units (37.5% vs. 2.2%) (p<0.001), patients who received 6 or more units of FFPs vs. less than 6 units (32% vs. 0%) (p<0.001), and patients who received 4 or more units of platelets vs. less than 4 units (50% vs. 4%) (p<0.001). Regarding early rebleeding and mortality, 5 of the 8 patients who died and 7 of the 101 patients who survived had another episode of bleeding within 30 days of presentation (41.7% vs. 3.1%) (p<0.001). There were not other statistically significant differences in the patients' characteristics when comparing those who died within 30 days and those who survived.
Conclusion: In patients admitted with bleeding secondary to esophageal varices, those with a MELD score ≥ 21 on admission, those with an episode of early rebleeding, and those who received either ≥ 10 units of RBCs, ≥ 6 units FFPs, or ≥ 4 units PLTs have a higher 30 day mortality.
