DIABETES AS A PREDICTOR OF MORTALITY IN CIRRHOTIC PATIENTS PRESENTING WITH VARICEAL BLEED

Abstract

Background; A major cause of cirrhosis-related morbidity and mortality is the development of variceal bleeding, a direct consequence of portal hypertension. Each episode of active variceal bleeding is associated with 30 percent mortality. This study was planned to determine frequency of variceal bleeding in patients with liver cirrhosis and frequency of in-hospital mortality of these patients in our population. Objective; To determine association of diabetes with mortality in patients with liver cirrhosis presenting with of variceal bleed. Material and Methods; Consecutive 139 Patient diagnosed with cirrhosis of liver were included in this cross-sectional study from department of Medicine, Nishtar hospital Multan. Complete history and physical examination was assessed to document duration of duration of liver disease, ascites, Hepatic encephalopathy, Previous GI bleed and systemic coagulopathy. All the patients had undergone diagnostic upper GI endoscopic examination to document varices. Results; Of these 139 study cases, 77 (55.4 %) were male and 62 (44.6 %) were female. Mean age of our study cases was 45.50 ± 10.81 years. Mean duration of disease (liver cirrhosis) was 3.25 ± 2.32 years. Majority of our study cases i.e. 94 (67.6%) were having liver cirrhosis for the duration of less than 5 years. Child-Pugh class C was more prevalent i.e. 77 (55.4%) of our study cases. Variceal bleeding was observed in 100 (71.9 %) of our study cases. Frequency of diabetes in cirrhotic patients with variceal bleed was 47 (33.81%) and mortality in these diabetics was 26 (55.31%) (p = 0.001). Conclusion; Diabetes was found to be significantly associated with mortality in cirrhotic patients presenting with variceal bleeding. Healthcare professionals should anticipate adverse outcomes in diabetic patients of liver cirrhosis presenting with variceal bleeding and should educate them regarding glycemic control at early stages of diagnosis. Keywords; Liver Cirrhosis, Variceal bleeding, Mortality. DOI : 10.7176/JMPB/58-01 Publication date : August 31 st 2019