Published online Nov 8, 2016. doi: 10.4254/wjh.v8.i31.1336
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
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.
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.
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).
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.
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.