Improved survival after variceal bleeding in patients with cirrhosis over the past two decades

TLDR

Variceal bleeding management has evolved over the past two decades with new treatment modalities. The study aimed to determine whether newer treatments improved prognosis in cirrhotic patients with variceal bleeding. The authors retrospectively reviewed liver ICU admissions for variceal bleeding in 1980, 1985, 1990, 1995, and 2000, noting a shift from balloon tamponade to vasoactive agents, endoscopic therapy, and antibiotics by 2000. In-hospital mortality fell from 42.6% to 14.5% overall, with marked reductions in each Child‑Turcotte‑Pugh class, rebleeding, and infection rates, and endoscopic therapy and antibiotics emerged as independent survival predictors, yielding a three‑fold mortality reduction. Citation: Hepatology 2004, 40:652‑659.

Abstract

Over the past two decades, new treatment modalities have been introduced for the management of variceal bleeding. The aim of this retrospective study in a single center was to assess whether these treatments have improved the prognosis for cirrhotic patients with variceal bleeding. We reviewed the clinical records of all patients with cirrhosis admitted to our Liver Intensive Care Unit due to variceal bleeding during the years 1980, 1985, 1990, 1995, and 2000. Whereas balloon tamponade was still the first-line treatment in 1980, patients treated in 2000 received a vasoactive agent, an endoscopic treatment, and an antibiotic prophylaxis in, respectively, 90%, 100%, and 94% of cases. The in-hospital mortality rate steadily decreased over the study period: 42.6%, 29.9%, 25%, 16.2%, and 14.5% in 1980, 1985, 1990, 1995, and 2000, respectively ( P < .05). Mortality decreased from 9% in 1980 to 0% in 2000 in Child-Turcotte-Pugh class A patients, from 46% to 0% in class B patients, and from 70% to 32% in class C patients. This improved survival was associated with a decrease of rebleeding (from 47% in 1980 to 13% in 2000) and bacterial infection rates (from 38% to 14%). On multivariable analysis, endoscopic therapy and antibiotic prophylaxis were independent predictors of survival. In conclusion , in-hospital mortality of patients with cirrhosis and variceal bleeding decreased threefold over the past two decades, in concurrence with an early and combined use of pharmacological and endoscopic therapies and short-term antibiotic prophylaxis. (Hepatology 2004;40:652-659.)