Abstract
Despite improvements over the past 20 years in patient survival following episodes of acute variceal hemorrhage (AVH) secondary to cirrhosis, AVH is still associated with a high rate of mortality. The ability to predict which patients are at high risk of death, or which are not likely to respond to standard therapy at admission to hospital is important, as it enables the immediate initiation of vasoactive drugs, early endoscopic intervention and prophylactic antibiotics. This commentary discusses a study that attempts to predict early rebleeding and mortality after AVH in patients with cirrhosis using the Model for End-stage Liver Disease. In this study, the model was a significant predictor of mortality; however, several defects in the study's design limit the conclusions that can be drawn from it. The model described in this study is neither more useful, nor more accurate, than those previously published for the prediction of rebleeding and mortality in patients with AVH.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Cholongitas E et al. (2006) A systematic review of the performance of the Model for End-stage Liver Disease (MELD) in the setting of liver transplantation. Liver Transpl 12: 1049–1061
Cholongitas E et al. (2005) Systematic review: Model for End-stage Liver Disease—should it replace Child–Pugh's classification for assessing prognosis in cirrhosis? Aliment Pharmacol Ther 22: 1079–1089
Bambha K et al. (2008) Predictors of early re-bleeding and mortality after acute variceal haemorrhage in patients with cirrhosis. Gut 57: 814–820
Burroughs AK et al. (2008) Predicting failure to control bleeding and mortality in acute variceal bleeding. J Hepatol 48: 185–188
Ben Ari Z et al. (1999) A predictive model for failure to control bleeding during acute variceal haemorrhage. J Hepatol 31: 443–450
Abraldes JG et al. (2008) Hepatic venous pressure gradient and prognosis in patients with acute variceal bleeding treated with pharmacologic and endoscopic therapy. J Hepatol 48: 229–236
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
AK Burroughs is on the speakers' bureau (honoraria) for Ferring Pharmaceuticals. CK Triantos, J O'Beirne and D Patch declared no competing interests.
Rights and permissions
About this article
Cite this article
Burroughs, A., Triantos, C., O'Beirne, J. et al. Predictors of early rebleeding and mortality after acute variceal hemorrhage in patients with cirrhosis. Nat Rev Gastroenterol Hepatol 6, 72–73 (2009). https://doi.org/10.1038/ncpgasthep1336
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ncpgasthep1336
This article is cited by
-
Use of self-expanding metal stents for difficult variceal bleed
Indian Journal of Gastroenterology (2017)
-
The effect of systemic antibiotic prophylaxis for cirrhotic patients with peptic ulcer bleeding after endoscopic interventions
Hepatology International (2013)
-
Rebleeding rates following TIPS for variceal hemorrhage in the Viatorr era: TIPS alone versus TIPS with variceal embolization
Hepatology International (2010)