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Risk factors for in-hospital mortality in cirrhotic patients with oesophageal variceal bleeding.
MedLine Citation:
PMID:  22356784     Owner:  NLM     Status:  Publisher    
INTRODUCTION: Oesophageal variceal bleeding (OVB) is a high mortality rate complication in patients with cirrhosis. The aim of this study was to assess the risk factors for in-hospital mortality (IHM) in cirrhotic patients with OVB. PATIENTS AND METHODS: The study cohort included 102 patients (average age, 55.4±12.6 years, 71.6% men) consecutively admitted to our hospital with OVB. All the patients underwent upper endoscopy within 12 h and octeotride or terlipressin therapy was started at admission and continued for 5 days. To calculate Model for End-Stage Liver Disease (MELD) and Child-Turcotte-Pugh scores, laboratory test data from blood samples taken within 6 h of admission were used. RESULTS: The IHM was 18.6% [19 patients; confidence interval (95% CI): 11.1-26.2%]. In the univariate analysis, transfusion with 2 or more units of packed red blood cells [PRBC; P=0.038; odds ratio (OR)=7.8; 95% CI: 1.2-61.3], platelets of 100/ml or less (P=0.014; OR=3.6; 95% CI: 1.2-10.3), Child-Turcotte-Pugh score of 10 or more (P=0.002; OR=4.0; 95% CI: 1.2-13.2) and MELD of 18 or more (P=0.044; OR=2.8; 95% CI: 1.1-8.1) were associated with IHM. In the multivariate analysis, transfusion with 2 or more units of PRBC (P=0.076; OR=6.7; 95% CI: 0.82-54.8), platelets of 100/ml or less (P=0.031; OR=3.4; 95% CI: 1.1-10.6) and MELD of 18 or more (P=0.048; OR=3.2; 95% CI: 1.02-10.1) remained independently associated with IHM. Applying a receiver operating characteristic analysis, the area under the curve derived from the multivariate analysis model was 0.76 (95% CI: 0.64-0.88) for IHM. CONCLUSION: Cirrhotic patients with OVB and MELD of 18 or more, platelets of 100/ml or less and requiring transfusion of 2 or more units of PRBC were at an increased risk of IHM. Overall, the logistic regression model correctly predicts 82.2% of IHM patients.
Rute Maria Cerqueira; Luis Andrade; Manuel Rodriguez Correia; Carolina Duesca Fernandes; Maria Conceição Manso
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-18
Journal Detail:
Title:  European journal of gastroenterology & hepatology     Volume:  -     ISSN:  1473-5687     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9000874     Medline TA:  Eur J Gastroenterol Hepatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
aDepartment of Gastroenterology bDepartment of Internal Medicine, S Sebastião Hospital, Santa Maria Feira cBiostatistics, Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal and REQUIMTE-UP, Portugal.
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