Prognostic indicators in cirrhotic patients with bleeeding oesophageal varices

الملخص EN

Bleeding oesophageal varices is an important came of morbidity and mortality in cirrhotic patients.

The aim of this study is to identify the risk factors that affect the prognosis in patients with liver cirrhosis presented with acute variceal bleeding through clinical and laboratory assessment.

This study included 200 cirrhotic patients who presented with bleeding oesophageal varices with mean age of 48.9 ± 11 A.years.

They were enrolled in prospective study and followedfor 6 weeks after the attack of bleeding .Patients were assessed using clinical, ultrasonographic, endoscopic and laboratory examinations.

Results: Hematemesis was controlled by vasoactive drugs in 132 cases (66%) while 68 cases (34%) continued to bleed and responded to balloon tamponade in (9.5%), sclerotherapy in (6%) and combinedprocedures in 18.5%.

Univariant analysis revealed that hepatic encephalopathy (p=0.001), malignant hepatic focal lesions on top of liver cirrhosis (P=0.013), ascites (P=0.000), albumin (P=0.000), bilirubin (P=0.01), prothrombin time (p= 0.001) and serum creatinine (P=0.000) were significantly affecting the survival.

.However, using logistic multivariant regression analysis for all variables revealed that three of seven variables significantly influenced the survival including the presence of hepatic focal lesion on top of liver cirrhosis (P=0.030), ascites (P=0.018) and prothrombin time (P=0.046) .

Total deaths within the first six weeks of index bleeding were 23 patients (11.5%).

Five of them (21.7%) died due to variceal bleeding, 9 patients (39.17 %) died due to liver cell failure, 6 patients (26%) died due to both liver cell failure and variceal bleeding and 3 patients (13%) died due to hepatorenal syndrome .The bleeding was higher in patients with Child grade C than B and A.

Non of the patients with Child A died after variceal bleeding, while the mortality rate in grade B was 3% and in grade C8.5%.

We conclude that the main factors that can independently affect the prognosis of cirrhotic patients with bleeding oesophageal varices are ascites, hepatocellular carcinoma on top of liver cirrhosis and prothrombin time.

Furthermore Child Pugh grade is an important prognostic factor