Clinical Outcomes of Upper Gastrointestinal Bleeding in Egyptian Patients with Decompensated Liver Cirrhosis, Does the Bleeding Source Matter?

Background: Upper gastrointestinal bleeding (UGIB) is a prevalent emergency and mortality cause in cirrhotic patients. It prolongs the hospital length of stay (LOS) and increases hospital readmission. Objectives: We investigated the clinical outcomes of acute variceal bleeding (AVB) and non-variceal bleeding (NVB) in patients with decompensated cirrhosis and the possible risk factors for prolonged hospital LOS. Patients and Methods: All patients with decompensated liver cirrhosis and UGIB (AVB & NVB) hospitalized from August 2018 to March 2019 were enrolled in this study. We assessed mortality rate, the hospital LOS and hospital readmission rate along with the probable risk factors associated with prolonged hospital LOS. Results: Our study included 582 patients with decompensated liver cirrhosis, 367 patients had AVB and 215 patients had NVB. There was no significant difference in mortality rate between both groups (11.4% vs. 9.3%, P= 0.43). The hospital LOS in AVB patients was longer than that in NVB group (5.8 ± 2.2 vs. 4.3 ± 1.8, p=0.001). Rate of hospital re-admission within 30 days was significantly higher in the AVB group (27%) compared to NVB group (18%). Inhospital re-bleeding and the need for repeated endoscopy were also higher in AVB patients (20%) than in NVB patients (12%). Risk factors for prolonged hospital LOS were development of hepatic encephalopathy, spontaneous bacterial peritonitis (SBP), in-hospital re-bleeding, Child C score and higher Model for end-stage liver disease (MELD) score. Conclusion: Patients with decompensated cirrhosis and AVB have longer hospital LOS and re-hospitalization rate than those with NVB with no significant difference in mortality rate between both groups.