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

Hans-Peter Erasmus1, Rukiye Bektas2, Katharina Orland2

  • 1Department of Internal Medicine I, Goethe University, Frankfurt, Germany.

European Journal of Gastroenterology & Hepatology
|October 20, 2020
PubMed

Insights

Gastrointestinal bleeding in cirrhosis patients shows higher mortality in males with variceal bleeding versus nonvariceal bleeding. Female mortality remains similar regardless of bleeding type, indicating a need for sex-specific management strategies.

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.
Abstract

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