Background and aims: Acute variceal hemorrhage (AVH) is the most serious encountered complication\nof liver cirrhosis and carries high mortality rate. Several risk factors that predict early\nrebleeding and mortality have been studied and there is no similar study in our country, so the\naim of this study was to identify the risk factors of early rebleeding and mortality after bleeding\nepisode in cirrhotic patients in Yemen. Patients and Method: It was a prospective study of cirrhotic\npatients with AVH who were admitted to the main public hospitals in Sanaââ?¬â?¢a between April 2014\nand March 2015. Demographic information, medical histories, physical examination findings, and\nlaboratory test results were collected. Endoscopic and pharmacologic treatment was performed.\nThe patients were followed up since admission and up to 6 weeks for the occurrence of rebleeding\nand mortality after the acute attack. Univariate and multivariate analyses were performed to\nidentify independent risk factors for rebleeding and mortality. Survival analysis was estimated\nusing the Kaplan-Meier method. Result: A total of 102 patients were analyzed. 26 patients (25.5%)\nrebleeded within 6 weeks period. The predictive factors significantly associated with rebleeding\nwithin 6 weeks period in univariate analysis were clot on varix at index endo- scope (P < 0.0001),\nhigh serum bilirubin (P = 0.02), CTP score (P < 0.05) and MELD score (P < 0.05). Independent risks\nfactors remained in multivariate analysis as significant predictors of early rebleeding were clot on\nvarix (OR: 11.6, CI: 2.87 - 47.29, P = 0.001) and high serum bilirubin (>3) (OR: 1.1, CI: 1.02 - 1.19, P\n= 0.01). Sixteen patients died (15.7%) within 6 weeks period. Predictors of mortality with\nsignificant difference in univariate analysis were hypovolemic shock (P = 0.001), high WBCs count\n(P < 0.0001), low serum sodium (P = 0.04), high AST (P < 0.0001), high ALT (P = 0.02), high INR (P\n< 0.0001), high serum bilirubin (P < 0.0001), low serum albumin (P = 0.005), ascites (P = 0.001), CTP score (P < 0.0001) and MELD score (P < 0.0001). By multiple regression analysis high MELD\nscore - 1.41, P < 0.0001) and WBCs over 10.3 Ã?â?? 109/l (OR: 1.2, CI: 1.02 - 1.40,\nP < 0.05) were independent risk factors for mortality within 6 weeks period. Conclusion: Early\nrebleeding in cirrhotic patients with AVH was associated with clot on varix at endoscope and high\nserum bilirubin more than 3 mg/dl. Early mortality rate was associated with high MELD score\n( and WBCs over 10.3 Ã?â?? 109/l.
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