Outcome and survival after acute variceal bleeding in patients with liver cirrhosis

Background:

Acute variceal bleeding (AVB) represents a severe complication of portal hypertension. Despite a decrease in mortality over the last decades, AVB-related mortality remains considerable. Recent data on the outcome and survival after AVB are limited.

Methods:

We assessed bleeding control (5 days), early rebleeding rates and bleeding-related mortality (6 weeks) and overall mortality in cirrhotic patients with AVB admitted to the Medical University Vienna (MUV) between 01/2000 – 12/2015. Independent risk factors for rebleeding and mortality were assessed by multivariate models.

Results:

N = 139 patients were included in this retrospective analysis: n = 91 (65.5%) were male; age: 56+/-12 years. Alcoholic liver disease (n = 77, 55.4%) and viral hepatitis (n = 23, 16.5%) were the most common etiologies. Failure to control bleeding was observed in n = 19 (13.7%) patients and bleeding-related mortality was 30.9% (n = 43). One year rebleeding rates were influenced by MELD-score (p < 0.001), Child-Pugh stage (p = 0.002) and presence of portal vein thrombosis (PVT, p = 0.012), but not by HCC (p = 0.168) nor by bleeding-while-on NSBBs (p = 0.201). In multivariate analysis only MELD score remained as independent predictor for bleeding-related mortality (OR: 1.14; p = 0,002). During a median follow-up of 11 months, n = 26 (18.7%) patients had TIPS implantations and n = 11 (7.9%) underwent liver transplantation. The overall mortality was 71.2% (n = 99/139). Transplant free survival was influenced by MELD (OR: 1.05; p < 0.001) and the presence of PVT (OR: 2.41; p = 0.017).

Conclusion:

We observed high bleeding-related mortality – which may be explained by the long study period and implementation of early TIPS only after 2010. MELD was the only independent prognostic factor for 6-week bleeding-related mortality. AVB while-on NSBBs had no influence on rebleeding or mortality. In addition to MELD and Child-Pugh stage, the presence of PVT was associated with rebleeding within the first year after AVB. In addition the presence of PVT was negatively associated with transplant-free survival.