AUSTROBAND: A prospective register of cirrhotic patients with acute variceal bleeding at the UK Sankt Pölten, an update

Background:

Epidemiologic data on incidence, treatment modalities and outcome of patients with acute variceal bleeding (AVB) at the UK Sankt Pölten is lacking. With this prospective register, we aim to improve evidence-based patient management.

Methods:

A prospective registry recruiting consecutive patients with AVB at the UK St. Pölten was implemented since 01/2018. Events of interest are (i) failure to control bleeding within 5 days, (ii) AVB-related mortality within 6 weeks, and (iii) overall survival. Patients' characteristics, laboratory parameters, treatment and implementation of secondary prophylaxis are documented.

Results:

Since January 2018, n = 17 patients (15 male, 88,2%) were included in the register. We observed a median MELD-score of 14, Child-Pugh (A: 6, B: 8, C: 3). Alcoholic liver disease was the most common etiology of liver cirrhosis (n = 13, 76,5%) followed by viral hepatitis (n = 2, 11,8%). Active bleeding at endoscopy was documented in n = 7 patients. Failure to control bleeding occurred in n = 3 patients, of which all patients died in the first six weeks of follow up. At the time of AVB, only 41,2% of cirrhotic patients had a sufficient primary/secondary prophylaxis. N = 14 patients had a sufficient secondary prophylaxis at the time point of hospital discharge. TIPS implantation was performed in n = 4 (23,5%) patients and n = 1 preexisting TIPS was reopened.

Conclusion:

During the first year of observation, we documented an expected number of AVB at our center. Three failures to control bleeding were observed, of which all patients died during follow up. A high percentage of cirrhotic patients isn't on sufficient prophylaxis until the first bleeding episode. TIPS implantation is regularly performed for secondary prophylaxis. Since 01/19 we include patients with elective elastic band ligations as well. Extension to other centers is planned.