Improved survival of cirrhotic patients with variceal bleeding over the decade 2000–2010 (original) (raw)

2015, Clinics and Research in Hepatology and Gastroenterology

Background and objective: Advances in the management of variceal bleeding (VB) have been highlighted recently. We aimed at assessing whether changing the management of VB has improved the outcome (mortality and rebleeding rates). Methods: The files of two cohorts (n = 57, 2000-2001 and n = 64, 2008-2009) of patients referred to our university center were reviewed after a cross-searching using two coding systems. Data were recorded during the six months after VB. Results: As compared to 2000-2001, more use of general anesthesia (25.4% vs. 11.1%; P = 0.049), band ligations (96.1% vs. 71.4%; P = 0.001), octreotide (95.3% vs. 80.7%; P = 0.012) and antibiotic prophylaxis (93.8% vs. 82.5%; P = 0.09) were performed in 2008-2009, whereas the number of red-cell units transfused during the hospital stay (4.3 ± 3.2 vs. 7.1 ± 5.7; P = 0.005) decreased. Surprisingly, more than 60% of patients reached the emergency department from home without medical assistance in both periods. In 2008-2009, patients had more comorbidities and no patients underwent early-TIPS but the 6-week mortality rate (24.6% vs.10.9%; P = 0.048) was lower. The 6-week mortality was associated with high MELD score Abbreviations: CCAM, classification commune des actes médicaux; CdAM, catalogue des actes médicaux; CRP, C-reactive protein; ICD, International Classification of Diseases; MDRD, modification of diet in renal disease; MELD, model of end stage liver disease; TIPS, transjugular intrahepatic portosystemic shunt; UGI, upper gastrointestinal; VB, variceal bleeding. * Corresponding author. Service d'hépatologie et de soins intensifs digestifs, hôpital Jean-Minjoz, D. Vuachet et al.