Upper GI bleed: a third of patients with varices died within two months.

Clinical bottom line (level 1b)

  1. A third of patients with bleeding oesophageal varices died within 2 months.
  2. Patients with the following factors were at increased risk of dying
    • old age
    • high Pugh score
    • alcoholism
    • hepatocellular carcinoma
Merkel et al: European Journal of Gastroenterology and Hepatology 1996; 8: 75-79
Expires January 2003

The study

Prospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: 8 acute hospitals, Italy

155 patients (aged aged 26 to 81; mean 59, 62% male) with oesophageal variceal bleeding and cirrhosis (histological diagnosis, ascites and varices)

Factors studied:
  • age, sex, severity of bleeding, Pugh score, alcoholism, alcohol intake, hepatocellular carcinoma

All patients had endoscopic sclerotherapy +/- balloon tamponade, vasoactive drugs and surgery if required.

Cox multiple regression analysis performed on prognostic factors.

100% followed for 1 to 4 years
Outcomes studied:
  • death at 60 days
  • death after ~2 years
 

The evidence

outcome time to outcome number of patients/total number %
(95% CI)		 NNF
(95% CI)
death 60 days 58/155 37.42%
(28.80% to 45.04%)		 3
(2 to 3)
death 1 to 4 years 86/155 55.48%
(47.66% to 63.31%)		 2
(2 to 2)

  • The following prognostic factors were independently associated with death: Pugh score, alcoholism, age and hepatocellular carcinoma.

Comments

  1. No odds ratios given for prognostic factors.

Citation

  1. Merkel C, Gatta A, Bellumat A, et al: Optimizing the time-frame for the definition of bleeding-related death after acute variceal bleeding in cirrhosis. European Journal of Gastroenterology and Hepatology 1996; 8: 75-79
Contributor: Chris Ball and Musab Hayatli, Unknown Month 1999
Reviewer:

Clinical Question.
Patient bleeding oesophageal varices
Intervention or Exposure prognostic factors
Outcome death