FAILURE TO CONTROL BLEEDING IN VARICEAL UPPER GASTROINTESTINAL BLEEDING IN PATIENTS WITH LIVER CIRRHOSIS

Aims:

Upper gastrointestinal bleeding may occur from either variceal or non-variceal sources. Failure to control bleeding is defined as an impossibility to manage the bleeding, including death, or rebleeding in the interval from the onset of bleeding and day 5. The aim of the study was to identify the main predictive factors of failure to control bleeding in variceal upper gastrointestinal bleeding (UGIB) in cirrhotic patients.

Methods:

This is a prospective study, who was performed on 184 cirrhotic patients who presented for variceal UGIB to the emergency department of a tertiary hospital during a period of 26 months. All patients were followed clinically (presence of ascies), biologically (platelets count, serum creatinine, albumin, total bilirubin and INR), and endoscopically (grade of esophageal varices). The patients were divided into two groups: patients with failure to control bleeding and those with bleeding controlled.

Results:

The rate of failure to control bleeding was 17.9%, of these, 48.5% died in the first 5 days (p < 0.001).

The following characteristics were noted by comparing patients with failure to control bleeding and those bleeding control: age 61.42 ± 10.41 vs. 58.43 ± 12.22 (p = 0.194); ascites 78.78% vs. 72.84% (p = 0.628); platelets count (no./mm³) ≤140.000: 72.72% vs. 83.44% (p = 0.234); serum albumin (g/dL) 2.82 (2.4; 3.45) vs. 3.3 (2.8; 3.5) (p = 0.002); serum bilirubin (mg/dL) 2.6 (1.35; 5.65) vs. 2.1 (1.4; 4) (p = 0.403); INR (international normalized ratio) 1.94 (1.51; 2.34) vs. 1.62 (1.47; 1.92) (p = 0.034); grade of esophageal: flattened 21.21% vs. 4.16% (p = 0.003).

Conclusions:

The predictive factors for failure to control bleeding in patients with variceal bleeding were: low serum albumin level, high serum creatinine and INR, and a higher severity grade of esophageal varices.