Prediction of outcome in patients with acute variceal haemorrhage

Abstract

Prediction of outcome in 87 patients following acute bleeding oesophageal and gastric varices due to portal hypertension from chronic liver disease was studied at our hospital over a 30-month period. The overall mortality rate was 26 per cent (23/87), with the operative mortality rate (50 per cent) being more than triple the non-operative mortality rate (14 per cent). The initial prothrombin time ratio (PTR) alone was significantly different in survivors and non-survivors both in the operated and non-operated patients. The only survivor in the whole material with a PTR greater than or equal to 2.2 was a patient who was transferred and underwent successful liver transplantation elsewhere. Among operated intensive care unit (ICU) patients, the Glasgow predictor gave a mean probability of discharge of 0.81 (s.d. 0.15) in 13 survivors and of 0.35 (s.d. 0.35) in the 15 non-survivors (P less than 0.001). In the 11 non-operative ICU patients, who had failed sclerotherapy, the Glasgow predictor could not be validated. Fourteen ICU deaths were associated with significant hypotension defined as a systolic blood pressure less than 90 mmHg for greater than 1 h.