Variceal bleeding has increased mortality compared to nonvariceal bleeding only in males

Area of Science:

• Gastroenterology
• Hepatology
• Clinical Medicine

Background:

• Gastrointestinal bleedings (GIBs) are common and serious complications in patients with liver cirrhosis.
• Conflicting data exists regarding the impact of bleeding type (variceal vs. nonvariceal) on mortality.
• Sex differences in mortality predictors for cirrhotic GIBs require further investigation.

Purpose of the Study:

• To investigate predictors of mortality in cirrhotic patients with upper GIB.
• To analyze the relationship between bleeding type (variceal vs. nonvariceal) and mortality.
• To explore sex-specific differences in mortality predictors and outcomes.

Main Methods:

• A cohort of 271 patients with suspected upper GIB undergoing endoscopy was analyzed.
• Patients were followed for up to 1 year post-admission.
• Univariate/multivariate regression and propensity score matching were used to identify mortality predictors and compare outcomes by sex and bleeding type.

Main Results:

• Males with variceal bleeding exhibited higher mortality compared to nonvariceal bleeding (NVB).
• Females showed similar mortality rates for both variceal and NVB.
• Independent mortality predictors differed between sexes, including MELD score, BUN, and ALT in males, and age, leukocytes, MELD, ascites, and hepatic encephalopathy in females.

Conclusions:

• Variceal bleeding carries a higher mortality risk for males compared to NVB, while this distinction is not observed in females.
• The findings underscore the importance of sex-specific clinical management strategies tailored to the type of GIB.
• Endoscopic findings and patient sex are crucial for stratifying mortality risk in cirrhotic GIBs.