Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 8, 2016; 8(31): 1336-1342
Published online Nov 8, 2016. doi: 10.4254/wjh.v8.i31.1336
Mortality and rebleeding following variceal haemorrhage in liver cirrhosis and periportal fibrosis
Sara Elfadil Abbas Mohammed, Abdelmunem Eltayeb Abdo, Hatim Mohamed Yousif Mudawi
Sara Elfadil Abbas Mohammed, Hatim Mohamed Yousif Mudawi, Department of Internal Medicine, Faculty of Medicine, University of Khartoum, Khartoum 11111, Sudan
Abdelmunem Eltayeb Abdo, National Centre for Gastrointestinal and Liver Disease, Ibn Sina specialized Hospital, Khartoum 11111, Sudan
Author contributions: Mohammed SEA contributed to concept, design, data collection, data analysis and drafting of the manuscript; Abdo AE contributed to concept, design, critical revision and final approval of the manuscript; Mudawi HMY contributed to concept, design, data interpretation, drafting and final approval of the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: The study was approved by the Research and Ethics Review Committee at Mohamed Salih Idris Bleeding Centre, Khartoum, Sudan.
Clinical trial registration statement: Not applicable, there were no interventions in this study.
Informed consent statement: All participants in the study or their legal guardian provided their informed consent before being enrolled in the study.
Conflict-of-interest statement: The authors of this manuscript have no conflict of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hatim Mohamed Yousif Mudawi, FRCP, Professor, Department of Internal Medicine, Faculty of Medicine, University of Khartoum, PO Box 2245, Khartoum 11111, Sudan. hmudawi@hotmail.com
Telephone: +249-91-2202600 Fax: +249-15-5117877
Received: May 20, 2016
Peer-review started: May 20, 2016
First decision: July 4, 2016
Revised: August 5, 2016
Accepted: August 27, 2016
Article in press: August 29, 2016
Published online: November 8, 2016
Processing time: 168 Days and 5.9 Hours
Abstract
AIM

To investigate mortality and rebleeding rate and identify associated risk factors at 6 wk and 5 d following acute variceal haemorrhage in patients with liver cirrhosis and schistosomal periportal fibrosis.

METHODS

This is a prospective study conducted during the period from March to December 2014. Patients with portal hypertension presenting with acute variceal haemorrhage secondary to either liver cirrhosis (group A) or schistosomal periportal fibroses (group B) presenting within 24 h of the onset of the bleeding were enrolled in the study and followed for a period of 6 wk. Analysis of data was done by Microsoft Excel and comparison between groups was done by Statistical Package of Social Sciences version 20 to calculate means and find the levels of statistical differences and define the mortality rates, the P value of < 0.05 was considered to be significant.

RESULTS

A total of 94 patients were enrolled in the study. Thirty-two patients (34%) had liver cirrhosis (group A) and 62 (66%) patients had periportal fibrosis (group B). Mortality: The 6-wk and 5-d mortality were 53% and 16% respectively in group A compared to 10% and 0% in group B (P value < 0.000 and < 0.004). In group A; a Child-Turcotte-Pugh class C and rebleeding within 5 d were significantly associated with 5-d mortality (P value < 0.029 and < 0.049 respectively) and Child- Turcotte-Pugh class C was also a significant risk factor for 6-wk mortality (P value < 0.018). In group B; mortality was significantly associated with rebleeding within the 6-wk follow-up period and requirement for blood transfusion on admission (P value < 0.005 and < 0.049). Rebleeding: The 6-wk and 5-d rebleeding rate in group A were 56% and 25% respectively compared to 32% and 3% in group B (P value < 0.015 and < 0.002). Clinical presentation with encephalopathy was a significant risk factor for 5 d rebleeding in group A (P value < 0.005) while grade III periportal fibrosis and requirement for blood transfusion on admission were significant risk factors for 6-wk rebleeding in group B (P value < 0.004 and < 0.02).

CONCLUSION

The 6-wk and 5-d mortality and rebleeding rate were significantly higher in patients with liver cirrhosis compared to patients with schistosomal periportal fibrosis.

Keywords: Variceal haemorrhage; Periportal fibrosis; Liver cirrhosis; Mortality; Rebleeding

Core tip: This study was conducted to investigate the rate and risk factors associated with rebleeding and mortality at 6 wk and 5 d following acute variceal haemorrhage in patients with liver cirrhosis and schistosomal periportal fibrosis (PPF). The 6-wk and 5-d mortality in cirrhosis were 56% and 16% compared to 10% and 0% in patients with schistosomal PPF (P value < 0.000 and < 0.004). The 6-wk and 5-d rebleeding rate in cirrhosis were also high at 53% and 25% compared to 32% and 3% respectively in patients with schistosomal PPF (P value < 0.015 and < 0.002). In conclusion the 6-wk and 5-d mortality and rebleeding were significantly higher in patients with liver cirrhosis compared to patients with schistosomal periportal fibrosis.