Afro-Egypt J Infect Endem Dis 2014 March ;4(1):13

 

Prevalence and Outcome of Bleeding Gastro-esophageal Varices in Medical Intensive Care Unit at Zagazig University Hospitals, Egypt

 

Abdelaziz A and Yousif M

 

Internal Medicine Department ,Faculty of Medicine,Zagazig University, Egypt
a.a.aziz2014@gmail.com

 

                              

 

ABSTRACT

Background and study aim:Ruptured gastro-esophageal varices (GEV) are the most severe and frequent cause of gastrointestinal bleeding in cirrhotic patients, leading to death in 5% to 8% of patients during the first 48 hours. Recently, the 6-week mortality rate has fallen from 34% to 20% due to the development of effective treatment strategies. This study was conducted to find out the prevalence of GEV as a cause of upper GI bleeding, a common medical emergency, and to find out the effect of other co-morbidities and risk factors on the outcome.

Patients and methods:This was an observational longitudinal prospective study. It included patients admitted to hematemesis subunit of medical ICU at Zagazig University Hospitals with endoscopic diagnosis of bleeding GEV in the period from May to September 2013. 448 patients were enrolled in this study. 374 patients of them were observed until stabilization and discharge (survived group) and 74 patients were observed throughout their stay in the medical ICU and unfortunately passed away (deceased group). All subjects of our study were subjected to complete history, full physical examination, routine investigations and upper GIT endoscopy.

Results : There was a significant positive correlation between hospital mortality and the age of the patients. The mean age of the deceased group was 59.44 ys ± 5.89 compared to 47.9 ys ± 9.93 of the survived group (p-value=0.036). Also the incidence of mortality in male sex was more than female sex (p-value= 0.005). The stage of liver disease according to Child-Pough class, MELD Score (model of end stage liver disease), the presence of complication of cirrhosis and abnormal liver functions (high serum bilirubin, elevated ALT, low serum albumin and prolonged INR) were the most important factors contributing to mortality in intensive care patients suffering from GEV bleeding (p-value= 0.002). The presence of co-morbid conditions (DM, COPD, renal failure), which were found in 20.3% of our patients, was associated with increased mortality (p-value=0.007). Severity of bleeding, delayed endoscopic intervension, hemodynamic instability (at the time of endoscopy), all were associated with increased risk of mortality. high APACHE II score (Acute Physiology and Chronic Health Evaluation) is associated with marked increase in mortality

Conclusion : Patients with variceal bleeding comprised a great burden to our medical ICU being about 13.7% of all admitted patients. The short term ICU mortality of these patients is 16.5%. The multivariate regression analysis identified the APACHE II score, MELD score, severity of the bleeding attacks, time to endoscopic intervention. ALT level, advancing age, presence of co-morbidities and spontaneous bacterial peritonitis (SBP) were found to be independent risk factors. So, primary and secondary prevention as well as better adherence to current guidelines for management of such cases to minimize the mortality as much as possible are recommended.