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News

Predictors of early re-bleeding and mortality after variceal hemorrhage

June‘s issue of Gut identifies predictors of early re-bleeding and mortality after acute variceal hemorrhage in patients with cirrhosis.

News image

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Risk factors for mortality and re-bleeding following acute variceal hemorrhage are incompletely understood.

Professor Kamath and colleagues from Minnesota, USA determined risk factors for 6-week mortality, and re-bleeding within 5 days in patients with cirrhosis and acute variceal hemorrhage.

The team used Kaplan-Meier and Cox proportional hazards regression analyses to determine risk factors among 256 patients with acute variceal hemorrhage entered into a randomized, prospective trial.

40% of deaths occurred within 5 days
Gut

The researchers found that 14% of patients died within 6 weeks of acute variceal hemorrhage.

The research team noted that 40% of deaths occurred within 5 days.

Only the Model for End-stage Liver Disease (MELD) score and units of packed red blood cells transfused in the first 24 hours were associated with 6-week mortality.

The team found re-bleeding within 5 days occurred in 15% of patients.

MELD score, and a clot on a varix predicted re-bleeding within 5 days.

Patients with a MELD score of 18, and 4 units of packed red blood cells transfused increased the risk of death in post-acute variceal hemorrhage.

A MELD score of 18, active bleeding at index endoscopy, and variceal re-bleeding increased the risk of death 6 weeks post-acute variceal hemorrhage.

Professor Kamath's team concluded, "Patients with acute variceal hemorrhage and MELD score 18, requiring 4 units of packed red blood cells within the first 24 hours or with active bleeding at endoscopy are at increased risk of dying within 6 weeks."

"MELD score 18 is also a strong predictor of variceal re-bleeding within the first 5 days."

Gut 2008: 57(6): 814-20
23 May 2008

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