COMPLICATION ASSOCIATED WITH UPPER GASTROINTESTINAL BLEEDING AMONG MEXICAN PATIENTS WITH CIRRHOSIS

Introduction and Objectives

Upper gastrointestinal bleeding is a common complication among cirrhotic patients and holds high mortality and morbidity; the most common cause is variceal hemorrhage. Nonetheless, non-variceal hemorrhage is also frequent; this study aims to determine the prevalence of upper gastrointestinal bleeding complications among Mexican patients with cirrhosis.

Methods

Retrospective, cross-sectional, an analytic study among patients with cirrhosis of all etiologies admitted to the Gastroenterology department of the Hospital General de Mexico “Dr. Eduardo Liceaga” with acute upper gastrointestinal bleeding of both etiologies (variceal and non-variceal hemorrhage) in the period comprised from January 2017 to May 2021. Complications associated with the bleeding events were evaluated. For statistical analysis, quantitative variables were described as mean and standard deviation for qualitative variables in frequencies and percentages.

Results

A total of 295 patients were included, 55.3% male, mean age was 54.6 ± 11.8 years, 16.27% patients were staged as Child A, 49.15% Child B y 34.57% Child C, with and an average MELD score of 16. Main cirrhosis etiology was alcohol-related liver disease in 39.7%, viral hepatitis 6.4%, NASH 5.8% and others 3.4%; however, in 44.7% of patients, we were not able to determine the etiology of liver disease. The main cause of gastrointestinal bleeding was variceal hemorrhage in 71.1% and 28.9% non-variceal. The shock was identified in 5.76% (17) of patients, 9 of them required vasopressors, hepatic encephalopathy was present in 42.71% (126), Ascites in 18.64% (55), jaundice in 16.94% (50), acute kidney injury in 31.52% (93), bacterial infections in 24.06% (71), four patients (1.35%) died. Complications related to gastrointestinal bleed according to disease severity are depicted in table 1.

Discussion and Conclusions

Complications associated with upper gastrointestinal bleeding among Mexican patients with cirrhosis are frequent. Encephalopathy is the most common (42.71%) followed by acute kidney injury (31.52%) preponderantly of high grade, patients with more advanced disease are more prone to present infections, mainly UTI and ascites. Therefore they must be monitored closely.

The authors declare that there is no conflict of interest.