Survival outcomes and predictors of mortality, re-bleeding and complications for acute severe variceal bleeding requiring balloon tamponade

Table 1 Baseline characteristics of patients with cirrhosis requiring balloon tamponade for acute severe variceal bleeding comparing death and survival at 6 wk

Variable (n = 75)	Survived (n = 40)	Death (n = 35)	P value
Male sex	30 (75.0)	28 (80.0)	0.783
Age in years	58 (48, 65)	54 (49, 65)	0.629
Cirrhosis aetiology: Alcoholic liver disease, Chronic viral hepatitis, NASH	26 (65.0), 16 (40.0), 6 (15.0)	28 (80.0), 14 (40.0), 1 (2.9)	0.199, 1.00, 0.113
Child-Pugh score	8 (7, 10)	11 (8, 12)	0.004
MELD score	14 (11, 18)	19 (16, 24)	< 0.001
AIMS65 score	2 (1, 2.5)	3 (2, 3)	0.004
Glasgow-Blatchford score	12 (9, 14)	12 (9, 15)	0.908
Complete Rockall score	8 (7, 8)	8 (7, 8)	0.159
HCC	2 (5.0)	9 (25.7)	0.019
Portal vein thrombosis	6 (15.0)	4 (11.4)	0.742
Antiplatelets or anticoagulants	7 (17.5)	2 (5.7)	0.162
Glasgow Coma Scale	15 (14, 15)	15 (14, 15)	0.503
Systolic blood pressure	101 (91, 123)	96 (76, 124)	0.328
Heart rate	95 (82, 114)	104 (91, 118)	0.304
Significant hypoxia (FiO2 > 35%)	10 (25.0)	13 (37.1)	0.319
Haemoglobin g/L	86 (74, 103)	78 (63, 111)	0.538
Platelets × 109/L	96 (72, 123)	110 (75, 150)	0.204
Albumin g/L	26 (22, 28)	22 (19, 28)	0.034
INR	1.5 (1.3, 1.7)	1.9 (1.5, 2.3)	< 0.001
Bilirubin μmol/L	29 (14, 54)	51 (29, 119)	0.003
Serum sodium mmol/L	139 (135, 141)	135 (129, 140)	0.025
Serum creatinine μmol/L	74 (62, 92)	95 (73, 124)	0.014
Serum pH	7.36 (7.26, 7.44)	7.30 (7.10, 7.41)	0.072
Lactate mmol/L	3.10 (1.65, 5.35)	5.20 (2.65, 9.80)	0.007

Categorical variables presented as number, (percentage) and continuous variables as median, (interquartile range). NASH: Non-alcoholic steatohepatitis; MELD: Model for end-stage liver disease; HCC: Hepatocellular carcinoma; FiO2: Fraction of inspired oxygen; INR: International normalised ratio.

Table 2 Management of index variceal bleed and characteristics around insertion of Sengstaken-Blakemore tube

Variable	Value (n = 80)
Vasoactive agent	79 (98.8)
Terlipressin	30 (37.5)
Octreotide	49 (61.3
Empiric antibiotics	77 (96.3)
Time to endoscopy from bleed, h	6.8 (4.2, 19.0)
Site of variceal bleed
Oesophageal varices	64 (80.0)
Gastric varices	16 (20.0)
Initial endoscopic therapy
Variceal band ligation	43 (53.8)
Cyanoacrylate injection	2 (2.5)
Indication for SBT insertion
Incomplete haemostasis	54 (67.5)
Poor endoscopic views	41 (51.2)
Approach for SBT insertion (n = 71)
Nasal	22 (31.0)
Oral	49 (69.0)
Confirmation of SBT position
X-ray	44 (55.0)
Direct endoscopic vision	18 (22.5)
No documentation	15 (18.8)
Gastric balloon inflation (n = 76)
Volume, mL	285 (250, 300)
Time inflated, h	26.8 (16.9, 44.7)
Oesophageal balloon inflation (n = 22)
Volume, mL	100 (39, 100)
Time inflated, h	20.5 (10.2, 36.8)
Therapy post-SBT deflation (n = 62)
Repeat endoscopic therapy	27 (43.5)
Further balloon tamponade	16 (20.0)

Categorical variables presented as number, (percentage) and continuous variables as median, (interquartile range). SBT: Sengstaken-Blakemore tube.

Table 3 Patient outcomes following Sengstaken-Blakemore Tube insertion

Variable	Value (n = 80)
Length of stay, d
Total hospital LOS	11.0 (7.0, 19.5)
ICU LOS	4.90 (2.3, 9.1)
Duration of mechanical ventilation, h	89.5 (39.3, 153.8)
Blood product transfusion
Packed red cells, units	6 (4, 10)
Platelets, units	1 (0, 3)
Fresh frozen plasma, units	2 (1, 6)
Achieved primary haemostasis	73 (91.3)
Re-bleeding	25 (34.2)
Complications of SBT	19 (34.5)
Mucosal ulceration and tears (without perforation)	17 (89.5)
Aspiration pneumonia	4 (21.0)
Perforation	1 (5.3)
TIPS
Underwent TIPS	17 (21.3)
Time to TIPS from SBT, d	2.95 (1.4, 4.1)
Survival
Survived hospital admission	41 (51.2)
Alive at 6 wk	41 (51.2)
Alive at 26 wk	39 (48.8)
Alive at 52 wk	37 (46.3)

Categorical variables presented as number, (percentage) and continuous variables as median, (interquartile range). LOS: Length of stay; SBT: Sengstaken-Blakemore tube; TIPS: Transjugular intrahepatic portosystemic shunt.

Table 4 Predictors of 6 wk mortality after acute severe variceal bleeding requiring balloon tamponade

Variable (n = 75)	Univariate analysis		Multivariate analysis (n = 68)
	OR (95%CI)	P value	OR (95%CI)	P value
Age	0.99 (0.95-1.04)	0.669	-	-
Male sex	1.33 (0.45-3.98)	0.606	-	-
Haemodynamic instability	2.01 (0.75-5.41)	0.167	-	-
INR	8.19 (2.10-31.89)	0.002	-	-
Albumin	0.924 (0.85-1.01)	0.063	-	-
Bilirubin	1.02 (1.01-1.030)	0.009	-	-
Creatinine	1.02 (1.01-1.035)	0.024	-	-
Sodium	0.93 (0.86-0.99)	0.045	-	-
pH	0.02 (0.01-0.68)	0.030	-	-
Lactate	1.16 (1.02-1.31)	0.019	-	-
AIMS65 score	1.96 (1.15-3.35)	0.014	-	-
GBS	0.98 (0.86-1.15)	0.767
Rockall score	1.44 (0.86-2.43)	0.168
Child-Pugh score	1.40 (1.01-1.80)	0.007	-	-
MELD score	1.22 (1.09-1.37)	< 0.001	1.21 (1.06-1.41)	0.006
HCC	6.58 (1.31-32.95)	0.022	11.51 (1.61-82.20)	0.015
Re-bleeding	8.76 (2.77-27.73)	< 0.001	13.06 (3.06- 55.71)	< 0.001
SBT complications	1.40 (0.44-4.51)	0.573	-	-
TIPS performed	0.30 (0.09-1.04)	0.058	-	-

INR: International normalised ratio; GBS: Glasgow-Blatchford score; MELD: Model for end-stage liver disease; HCC: Hepatocellular carcinoma; SBT: Sengstaken-Blakemore tube; TIPS: Transjugular intrahepatic portosystemic shunt.

Table 5 Outcomes for patients who re-bled after Sengstaken-Blakemore tube insertion for acute severe variceal bleeding

Variable (n = 73)	No Re-bleeding (n = 48)	Re-bleeding (n = 25)	P value
Duration of mechanical ventilation (h)	86.0 (46.0, 134.5)	138.0 (79.0, 210.0)	0.026
No. of packed RBC transfused	5 (3, 7)	10 (5, 16)	0.001
No. of platelets transfused	1 (0, 2)	1 (0, 4)	0.430
No. of FFP transfused	2 (0, 4)	6 (2, 14)	0.001
6 wk mortality	13 (27.1)	19 (76.0)	< 0.001

Categorical variables presented as number, (percentage) and continuous variables as median, (interquartile range). RBC: Red blood cells; FFP: Fresh frozen plasma.