• Tahir Mehmood, Muhammad Qasim Zia, Ansar Latif, and Saad Ansar.
• Department of Emergency Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
• J Coll Physicians Surg Pak. 2019 Dec 1; 29 (12): 1199-1202.

ObjectiveTo find and analyse the associated determinants of mortality in admitted patients in cirrhotic patients with MELD score >18 presenting in emergency department with variceal bleeding.Study DesignCross-sectional study.Place And Duration Of StudyDepartment of Emergency Medicine, King Sultan Military Hospital Riyadh, Kingdom of Saudi Arabia, from July 2017 to January 2018.MethodologyA total of 235 patients fulfilling the inclusion criteria were enrolled in the study. Diagnosis of cirrhosis was made if the patients had platelets <150000/μl, PT >3 sec (prolonged), biochemical (reversal of ALT, AST ratio, albumin <3.5 g/dl) and ultrasongraphic coarse echotexture of liver and splenomegaly; and presence of all of the above variables and for at least six months. Variceal bleeding diagnosed on presentation and emergency endoscopy. MELD score was calculated by following formula. MELD = 3.78 [Ln serum bilirubin (mg/dL)] +11.2 [Ln INR] +9.57 [Ln serum creatinine (mg/dl)] +6.430 NR. Outcome of patients treatment was to record associated morbidity and mortality during follow-up period of one month.ResultsThere were 156 (66.4%) male and 79 (33.6%) female cirrhotic patients. The mean age was 47.8 ±8.7 years. Out of 235 patients of liver cirrhosis, 47 (20.0%) expired during the hospital stay, while 188 (80.0%) patients survived and discharged from the hospital. Most of the cirrhotic patients were experienced with MELD score 18-20, i.e. 144 (61.3%) followed by 70 (29.8%) in 21-25 and 21 (8.9%) had the range of 26-30. In-hospital mortality rate was statistically insignificant (p>0.05) with respect to MELD scores. Probability of survival was 0.80.ConclusionLiver cirrhosis with MELD score >18 and variceal bleeding is highly prevalent in young adult patients, more likely in male patients having duration of disease since >1 year to 3 years such that every 1 of 5 patients expired during the hospital stay. Probability of survival was 80%.

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