Korean J Helicobacter Up Gastrointest Res.  2013 Dec;13(4):235-242. 10.7704/kjhugr.2013.13.4.235.

The Clinical Features and Prognostic Factors of Nonvariceal Upper Gastrointestinal Bleeding in the Patients with Liver Cirrhosis

• Jo YW
• Choi JY
• Ha CY
• Min HJ
• Lee OJ

• KMID: 1865971
• DOI: http://doi.org/10.7704/kjhugr.2013.13.4.235

Abstract

BACKGROUND/AIMS
Variceal rupture is the most common cause of upper gastrointestinal bleeding (UGIB) in cirrhotic patients and is well investigated. However, there are few documented studies on nonvariceal UGIB (NVUGIB) in these patients. This study was conducted to evaluate clinical features, in-hospital mortality rate and factors associated with mortality in cirrhotic patients with NVUGIB.
MATERIALS AND METHODS
Among 399 cirrhotic patients who presented UGIB at Gyeongsang National University Hospital during 5 years since January 2007, patients with NVUGIB were selected by retrospective review of medical records. The patients' clinical and endoscopic findings, treatment outcomes, in-hospital mortality rates and its risk factors were investigated.
RESULTS
NVUGIB was documented in 83 patients (20.8%). Mean age was 60.7+/-9.7 years, 85.5% was male. Child-Pugh class was A or B in 88%. Initial hemodynamic instability was reported in 25.3%, and 65.1% required blood transfusions. The major bleeding source was peptic ulcer 95.2% (79/83), and 44.6% (37/83) had endoscopic high risk bleeding stigmata and required endoscopic hemostasis. Rebleeding rate was 7.2% and in-hospital mortality rate was 8.4%. Hemodynamic instability (71.4% vs. 22.4%, P=0.013) and rebleeding (57.1% vs. 2.6%, P=0.000) were more frequent in the mortality group compared to the survival group. Hemodynamic instability was the risk factor for mortality at univariate and multivariate analyses.
CONCLUSIONS
NVUGIB accounted for 20.8% of UGIB in liver cirrhosis and its development was not related to liver function. Peptic ulcer was the major cause and 45% required endoscopic hemostasis. It's in-hospital mortality rate was 8.4%, and hemodynamic instability was an independent risk factor of mortality in NVUGIB.

Keyword

Liver cirrhosis; Nonvariceal upper gastrointestinal bleeding; Mortality

MeSH Terms

Blood Transfusion
Christianity
Hemodynamics
Hemorrhage*
Hemostasis, Endoscopic
Hospital Mortality
Humans
Liver Cirrhosis*
Liver*
Male
Medical Records
Mortality
Peptic Ulcer
Retrospective Studies
Risk Factors
Rupture