Short- and long-term outcomes for patients with variceal haemorrhage in a tertiary hospital

M. Halland, S. J. Ansley, B. J. Stokes, M. N. Fitzgerald, K. J. Inder, J. M. Duggan, A. Duggan

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Background/Aim: To determine short- and long-term outcomes among a cohort of patients with variceal haemorrhage at a tertiary referral centre, and to determine the predictive value of the model for end-stage liver disease (MELD) score for mortality in these patients. Methods: Prospective database hospital audit that captured patients who presented with or were transferred with variceal haemorrhage between 2004 and 2008, and a retrospective review of long-term outcomes. Patients who presented to or were transferred to John Hunter Hospital, a tertiary referral hospital, with confirmed variceal bleeding were included. The main outcome measures were in-hospital, 6 weeks and end-of-audit mortality. We also recorded cause, location and degree of planning surrounding the deaths in this patient group. We analysed the MELD score for patients with complete survival data. Results: We recorded 93 episodes of variceal haemorrhage from 78 unique patients during the initial study period. The in-hospital mortality, 6 weeks mortality and end-of-audit mortality were 2.6, 9.0 and 59, respectively, and median survival time was 3.2 years (95% confidence interval 0.0, 6.1). The most frequent cause of death was related to complications of end-stage liver disease at 74%, followed by variceal bleeding (19%) and unknown (6%). A Cox proportional hazard model showed that the risk of mortality is increased by 1.06 (1.01-1.11) for each unit increase in MELD score. Conclusions: Short-term outcomes for patients with variceal bleeding continue to improve, but long-term prognosis remains guarded and should prompt further emphasis on advanced care planning to optimise patient care.

Original languageEnglish (US)
Pages (from-to)234-239
Number of pages6
JournalInternal Medicine Journal
Volume43
Issue number3
DOIs
StatePublished - Mar 1 2013

Keywords

  • Advanced care planning
  • Epidemiology
  • Long-term outcomes
  • MELD score
  • Portal hypertension
  • Variceal haemorrhage

ASJC Scopus subject areas

  • Internal Medicine

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    Halland, M., Ansley, S. J., Stokes, B. J., Fitzgerald, M. N., Inder, K. J., Duggan, J. M., & Duggan, A. (2013). Short- and long-term outcomes for patients with variceal haemorrhage in a tertiary hospital. Internal Medicine Journal, 43(3), 234-239. https://doi.org/10.1111/imj.12037