PREDICTIVE FACTORS FOR GASTROINTESTINAL BLEEDING SECONDARY TO PORTAL HYPERTENSION DURING CIRRHOSIS

Aims Upper gastrointestinal bleeding by rupture of oesophageal varices (OV) or gastric varices (GV) is the most serious complication of portal hypertension in cirrhotic patients. The purpose of our work is to identify the predictive factors for the occurrence of hemorrhage in these patients.

Methods Retrospective study collecting cirrhotic patients between January 2015 and September 2019.

Results Seventy one patients of mean age of 62 years (between 25 and 83 years) were collected. The viral cause of cirrhosis was the most common (40.8%). OV were present in 87.73 % of patients. They were grade II or III in 71.8% of cases. GV were present in 11.2%. GHP was present in 56.3%: mild (29.5%), moderate to severe in 26.8% of cases. Red signs were found in 49.3%. Digestive haemorrhage by oesophageal varices rupture occurred in 15.4% of patients. Hemorrhage was attributed to severe hypertensive gastropathy in 2 cases (2.8%). The occurrence of a first episode of gastrointestinal bleeding secondary to portal hypertension was correlated with the presence of large OV (p = 0.003), red signs (p = 0.004) and hypertensive gastropathy (p = 0.004) and a MELD score> 15 (p = 0.001). A platelet count <100,000 el/mm3 was more frequent in patients presenting gastrointestinal bleeding, without significant difference (81.8% vs 45%, p = 0.12). There were no statistically significant differences in sex, etiology of cirrhosis, portal thrombosis, ascitic decompensation or refractory ascites.

Conclusions In our series, gastrointestinal bleeding secondary to portal hypertension occured in 18.2% of patients and was correlated with the presence of large oesophageal varices, red signs, hypertensive gastropathy, and advanced liver disease.