Determinants of Re Bleeding and Mortality in Cirrhotic Patients after Variceal Bleeding

Background: Variceal bleeding (VB) is the most serious complication of liver cirrhosis and carries a high mortality rate. Methods: The retrospective analysis on 263 cirrhotic patients with variceal bleeding in Taipei Medical University Shuang Ho hospital from 2012 to 2018. Aim: determine determinants of re-bleeding and mortality. Results: Patients’ characters were median age (56 years), male (73.4%), HCC (28.1%), ascites (53.2%), portal vein thrombosis (PVT, 6.4%), mean MELD score (17.5); mean Child-Tourette-Pugh score (CTP=8.2) and active bleeding at endoscopy (44.8%). Variceal re-bleeding occurred 4.1% at day-five, 11.0% at week-six and 28.1% at year-one. CTP score>7, MELD score>16, bilirubin>30mg/dL, hepatic encephalopathy and HCC predicted early and late re-bleeding. Old age, renal injury, active bleeding, albumin<2.8 g/dL, ascites, bacterial infection and PVT determined early re-bleeding. The mortality after first VB was 3.8%, 14.1% and 25.8% at day-5, week-6 and year-1 respectively. Old age, CTP>7, MELD>16, renal injury, ascites, hepatic encephalopathy, bacterial infection and HCC were determined early and late mortality. Early variceal re-bleeding was associated with early mortality. Use of non-selective beta-blocker or variceal ligation reduced mortality at year-1 (Odds Ratio; OR 0.03 and OR 0.3) and combination therapy reduced early re-bleeding (OR 7.5). Conclusion: Re-bleeding and mortality rate after VB were substantially high in hepatic decompensation, renal injury, presence of HCC, PVT and infection. Early identification of variceal bleeding patients who are at substantially high risk would probably benefit from early trans-jugular intrahepatic portosystemic shunt or liver transplantation.