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BACKGROUND: Despite advances in treatment, acute variceal haemorrhage remains life-threatening. AIM: To describe contemporary characteristics, management and outcomes of patients with cirrhosis and acute variceal haemorrhage and risk factors for rebleeding and mortality. METHODS: Multi-centre clinical audit conducted in 212 UK hospitals. RESULTS: In 526 cases of acute variceal haemorrhage, 66% underwent endoscopy within 24h with 64% (n=339) receiving endoscopic therapy. Prior to endoscopy, 57% (n=299) received proton pump inhibitors, 44% (n=232) vasopressors and 27% (n=144) antibiotics. 73% (n=386) received red cell transfusion, 35% (n=184) fresh frozen plasma and 14% (n=76) platelets, with widely varying transfusion thresholds. 26% (n=135) experienced further bleeding and 15% (n=80) died by day 30. The Model for End Stage Liver Disease score was the best predictor of mortality (area under the receiver operating curve=0.74, P<0.001). Neither the clinical nor full Rockall scores were useful predictors of outcome. Coagulopathy was strongly associated with rebleeding (odds ratio 2.23, 95% CI 1.22-4.07, P=0.01, up to day 30) and mortality (odds ratio 3.06, 95% CI 1.29-7.26, P=0.01). CONCLUSIONS: Although mortality has improved following acute variceal haemorrhage, rebleeding rates remain appreciably high. There are notable deficiencies in the use of vasopressors and endoscopic therapy. More work is needed to understand the optimum transfusion strategies. Better risk stratification tools are required to identify patients needing more intensive support.

Original publication

DOI

10.1016/j.dld.2013.12.010

Type

Journal article

Journal

Dig Liver Dis

Publication Date

05/2014

Volume

46

Pages

419 - 426

Keywords

Cirrhosis, Transfusion, Variceal bleeding, Adult, Aged, Anti-Bacterial Agents, Area Under Curve, End Stage Liver Disease, Erythrocyte Transfusion, Esophageal and Gastric Varices, Female, Gastrointestinal Hemorrhage, Hemostasis, Endoscopic, Humans, Liver Cirrhosis, Male, Medical Audit, Middle Aged, Platelet Transfusion, Proton Pump Inhibitors, ROC Curve, Recurrence, Risk Assessment, Severity of Illness Index, Time-to-Treatment, Treatment Outcome, United Kingdom, Vasoconstrictor Agents