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Comparison of scoring systems for patients with severe variceal bleeding

A study in the most recent Alimentary Pharmacology & Therapeutics compares scoring systems and outcomes of patients admitted to a liver intensive care unit of a tertiary referral centre with severe variceal bleeding.

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Acute variceal hemorrhage is associated with significant mortality.

Professor Julia Wendon and colleagues from the United Kingdom determined outcome and factors associated with hospital mortality in patients with acute variceal hemorrhage admitted to intensive care unit (ICU).

The team compared outcomes of patients requiring transfer to a tertiary ICU to a local in-patient group.

A retrospective study of all adult patients admitted to ICU with acute variceal hemorrhage from 20002008 was performed.

Median age was 48 years, and males represented 58%.

The team found that the median MELD score was 16, and SOFA score was 8.

HM was higher in patients who had severe liver disease or critical illness measured by MELD, SOFA, APACHE II scores and number of failed organs.

The researchers found that patients with day-1 lactate ≥ 2 mmol/L had increased hospital mortality.
Patients requiring transfer had less severe liver disease
Alimentary Pharmacology & Therapeutics

The team observed that MELD score performed as well as APACHE II, SOFA and number of failed organs in predicting hospital mortality.

Re-bleeding was associated with increased hospital mortality.

The team noted that the patients requiring transfer had less severe liver disease and critical illness, and consequently had lower hospital mortality than local patients.

Transferred patients with ≥2 endoscopies prior to transfer had increased 6-week mortality.

The researchers found that time from bleeding to transfer ≥3 days was associated with re-bleeding.

Professor Wendon's team concludes, "MELD score was comparable to ICU prognostic models in predicting mortality."

"Blood lactate was also predictive of hospital mortality."

"Delays in referrals and repeated endoscopy were associated with increased re-bleeding and mortality in this group."

Aliment Pharmacol Ther 2014: 39(11): 12861300
16 May 2014

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