الفهرس 
Aim of The WorkOnly 14 pages are availabe for public view
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Abstract
Summary
Acute variceal bleeding is one of the dreaded complications of liver cirrhosis which is unfortunately common in Egypt and carrying a high mortality risk.
Specific measures for managing acute variceal bleeding include pharmacological therapy as well as EGD to be performed quickly as possible, after ensuring general measures stabilizing the patient’s hemodynamics as well as antibiotic intake.
The present study was carried out on 90 consecutive cirrhotic patients (64 males & 26 females with a mean age 56.9±8.5 Ys) presenting with acute variceal bleeding and admitted to the Department of Hepatology, Gastroenterology and Infectious Diseases , Benha University Hospitals within the period between November 2009 to April 2012.
The etiology of cirrhosis in the studied cases was HCV in 79 patients, HBV in 4, combined HBV and HCV in 1 and 6 patients were negative to both HCV-Ab and HBsAg.
The studied cases were subdivided into two groups: survivors (group I) that comprised 70 patients (77.8%) and non survivors (group II) that comprised 20 patients (22.2%).
The present study revealed that, the in-hospital mortality rate was 22.2% . This is a relatively high figure which may be attributed to the delayed door-to-scope time because of our hospital schedule and absence of emergency endoscopy in this period beside the absence of advanced procedures to control bleeding like TIPS and emergency shunt surgeries that are available in the hospitals of other studies .
In the present study, there was a statistically highly significant relationship (P<0.001) between the presence of HE, HCC, ascites, higher Child scores, number of transfused blood and in-hospital mortality.
The present study found that there was a statistically highly significant relationship (P<0.001) between serum albumin level, hemoglobulin concentration and hematocrit value and in-hospital mortality. The lower the serum albumin level, the higher the in-hospital mortality.
The ROC curve and stepwise logistic regression analysis in the present study showed that the MELD score (which depends on highly significant parameters namely serum creatinine, serum total bilirubin and prothrombin time) was a statistically highly significant (P<0.001) predictor of in-hospital mortality when it is > 18 and it was the most significant parameter in this study.
Applying stepwise logistic regression analysis, the presence of active bleeding on endoscopy and rebleeding within 24 hours were associated with a statistically highly significant (P<0.001) occurrence of in-hospital mortality in the present study.
Conclusions
Post HCV cirrhosis was the commonest cause of acute variceal bleeding in present study with males more affection than females.
In-hospital mortality rate in the present study was 22.2% .
The presence of ascites, HE and HCC could significantly predict the in-hospital mortality from acute variceal bleeding.
The more the amount of blood units needed for transfusion in patients with acute variceal bleeding, the more the in-hospital mortality.
MELD score and child-pugh score are highly significant predictors of in-hospital mortality.
Low serum albumin level and hemoglobin concentration at time of presentation of patients with acute variceal bleeding have bad prognosis.
The presence of active bleeding at endoscopy should attract the Attention towards strict follow up of patients during in-hospital period.
Rebleeding within 24 hours after endoscopy carries a high in-hospital mortality risk.
The most highly significant predictors of in-hospital mortality in acute variceal bleeding were MELD score >18, followed by active bleeding on endoscopy, rebleeding within 24 hrs, S.creatinine >1.5 mg/dl , S.bilirubin >3 mg/dl, PT > 20 sec. and Previous attack(s), in order of importance.