6-Week mortality predictors in patients with acute variceal bleeding from the western national medical center of the Mexican social security institute

Introduction and Objectives

To identify the predictive factors for mortality at six weeks in patients with variceal bleeding.

Materials and methods

A retrospective cohort study in the Department of Gastroenterology of the National Medical Center of the West, from January-December 2021.

Results

Seventy patients with variceal bleeding were included (table 1). The 6-week mortality was 25.7% and the early rebleeding rate was 22.9%. The main predictors of mortality were a Child-Pugh class C score OR 7.67(95% CI, 2.25-26.15, p=0.0011), a MELD score ≥20 OR 20.0(95% CI, 5.58-94.74, p=<0.0001), ABC score ≥8 OR 32.0(95% CI, 3.91-261.54, p=0.0012) and Blatchford score ≥15 OR 9.60(95% CI, 2.51-38.16, p=0.0013); Similarly, the presence of other decompensations such as acute kidney injury (OR 4.77, p=0.0088), hepatic encephalopathy (OR 18.85, p=<0.0001), ACLF (OR 65.0, p=<0.0001), and a no-SBP infection (OR 3.83, p=<0.0001) were identified as predictors

Discussion

The mortality at six weeks and early rebleeding, as well as mortality predictors, match what is reported in the international literature.

Conclusions

Poor hepatic function reserve, which is related to higher comparisons of Child-Pugh and MELD scores, are independent predictors of mortality in variceal bleeding due to the high portal venous pressure gradients managed by these patients. Similarly, the presence of other decompensations, such as acute kidney injury, hepatic encephalopathy, and ACLF, also increase the risk of death when they occur in conjunction with variceal bleeding.

Funding

The resources used in this study were from the hospital without any additional financing

Declaration of interest

The authors declare no potential conflicts of interest.