No Factors ID'd to Predict Re-Bleeding With Non-High-Risk Acute Variceal Bleeding

FRIDAY, Dec. 15, 2023 (HealthDay News) -- The majority of non-high-risk patients with acute variceal bleeding (AVB) have an excellent prognosis, but those who do re-bleed have higher risk of death, according to a study published online Oct. 16 in the Journal of Hepatology.

Lorenz Balcar, M.D., from the Medical University of Vienna, and colleagues examined prognostic factors for re-bleeding and mortality in non-high-risk AVB. Analysis included 2,225 adults with cirrhosis and variceal bleeding who were prospectively recruited from 34 centers (2011 to 2015).

The researchers found that 15 percent of patients re-bled and 12 percent died within one year of initial bleed. Based on routine clinical data, there were no meaningful predictors of re-bleeding. However, re-bleeding was associated with increased mortality, even after accounting for differences in patient characteristics (adjusted cause-specific hazard ratio: 2.57). Risk of death was stratified by a nomogram including Child-Turcotte-Pugh, creatinine, and sodium measured at baseline accurately (concordance: 0.752).

"Our study paves the way for future clinical trials evaluating whether elective transjugular intrahepatic portosystemic shunt placement improves outcomes in presumably 'non-high-risk' patients who are identified as being at increased risk of death," the authors write.

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