Factors predicting in-hospital mortality in patients with cirrhosis hospitalized with gastro-esophageal variceal hemorrhage

Aim: To identify factors at the time of admission that predict in-hospital mortality in patients with gastroesophageal variceal hemorrhage. Methods: Case records of patients admitted with gastro-esophageal variceal hemorrhage between January 1998 and October 2003 were retrospectively analyzed. Relevant clinical and laboratory parameters, and their relationship to mortality, were studied. Clinical parameters assessed included Child-Pugh class, ascites, portosystemic encephalopathy (PSE), and occurrence of rebleed within 24 hours of esophagogastroduodenoscopy. The laboratory parameters assessed were: hemoglobin, prothrombin time, serum bilirubin, creatinine, and albumin. Results: Of the 343 patients admitted during the study period, 30 (8.7%) died in hospital. Serum bilirubin (2.4 versus 1.6 mg/dL) and serum creatinine (2.1 vs 1.1 mg/dL) levels were higher among non-survivors than among survivors. Non-survivors were also more likely to suffer from PSE (53%) than survivors (17%), while rebleeding within 24 hours of endoscopy occurred in 40% and 5% of these groups, respectively. On multivariate analysis, serum creatinine >1.5 mg/dL at the time of admission (p<0.001), serum bilirubin >3 mg/dL (p<0.001), presence of PSE (p=0.003), and rebleed within 24 hours of endoscopy (p<0.001) were significant predictors of mortality. Conclusion: Serum creatinine and bilirubin levels, presence of PSE, and rebleeding within 24 hours of initial endoscopy are independent predictors of mortality in patients with gastro-esophageal variceal bleeding.