• Amrendra Kumar Mandal, Mukesh Sharma Paudel, Sudhamshu Kc, Sitaram Chaudhary, Bidhan Nidhi Paudel, Nandu Silwal Poudyal, Barun Shrestha, Binod Karki, Suresh Thapa, Dibas Khadka, Rajan Kanth, and Paritosh Kafle.
• Gastroenterology Unit, Department of Medicine, Bir Hospital, Nepal.
• JNMA J Nepal Med Assoc. 2018 Jan 1; 56 (209): 493-496.

IntroductionAcute variceal bleeding in liver cirrhosis is an immediate life-threatening condition and amajor complication of portal hypertension associated with higher morbidity, mortality and hospital costs than any other causes of UGI bleeding. Therefore, early stratification and initiation of therapy based on several factors can reduce mortality associated with it. We aimed to study the predictors of mortality in acute variceal bleeding in LC.MethodsAn observational prospective study was conducted in Gastroenterology and Hepatology units of Bir Hospital, Kathmandu, Nepal from April 1, 2016 to May 30, 2017. Patients were included if they had underlying liver cirrhosis and presented upper GI bleeding which were proven to be secondary to variceal bleeding.ResultsSeventy-five patients with mean age of 52.5 years were available or the analysis. The M:F ratio was 2.1:1. There were 66 patients in mortality group and 9 in survivor group. The mean CTP and MELD score were 10.17±1.66 and 20.40±8.29 respectively. Among the predictors of the mortality studied, CTP score, MELD score, mean arterial pressure, Serum bilirubin, serum creatinine, need of FFP as well as PRP transfusion, presence of hepatorenal syndrome and hepatic encephalopathy were high in mortality group with statistical significance. On multivariate analysis, high CTP and high serum creatinine level were only significant predictors of mortality. Receiver operating curve for predicting accuracy of mortality was significant with higher MELD and higher CTP score.ConclusionsStrong predictors of mortality in patients with cirrhosis presenting with variceal bleeding are CTP score and high serum creatinine level.

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