Related Experiment Video
Updated: Jun 1, 2026
Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
Published on: November 15, 2024
Impact of Cirrhosis Etiology and Intensive Care Accessibility on Upper Gastrointestinal Bleeding: A Prospective
Mariana Barros Marcondes1, Clara Fantinelli Moreno1, Cíntia Mitsue Pereira Suzuki1
1Department of Internal Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil, unesp.br.
Background:
Upper gastrointestinal bleeding (UGIB) is a significant cause of cirrhosis decompensation; however, there is still controversy on risk factors for poor outcomes. This study aims to explore the impact of additional variables, such as liver disease etiology and intensive care unit (ICU) accessibility, on mortality, rebleeding, and infection rates.
Methods:
Cox regression analysis was employed to identify predictors associated with mortality and rebleeding, while Poisson regression analysis was utilized to assess associations with infections.
Results:
A total of 228 patients were included, with the majority classified as Child-Pugh B and C. Among them, 96 patients (42.1%) had alcohol-associated liver disease (ALD), of which 45 (46.9%) were in alcohol abstinence. One hundred and ninety-five patients (85.5%) survived, while 33 (14.5%) died. Intubation was required for 31 patients (13.6%), and 28 were transferred to the ICU. Antibiotic prophylaxis was administered to 219 patients (96%), and 55 (24.1%) developed infections. Both orotracheal intubation and transfusions were associated with high mortality, whereas ALD was linked to a lower risk of death (p < 0.001, 0.029, and 0.005, respectively). Intubation was also correlated with an increased risk of rebleeding, while transfer to ICU reduced this complication (p = 0.012 and 0.045, respectively). The Child-Pugh score and length of hospitalization were associated with the occurrence of infections (p = 0.037 and < 0.001, respectively).
Conclusions:
Intubation, transfusions, liver disease etiology, and ICU accessibility are critical predictors following UGIB in cirrhosis. Additionally, the Child-Pugh score and duration of hospitalization are directly proportional to the risk of infections in this context.
Trial Registration:
ClinicalTrials.gov identifier: NCT04662918.
Related Concept Videos
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
01:23Cirrhosis I: Introduction
01:24Esophageal Varices-I: Introduction
01:24Cirrhosis II: Pathophysiology
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
01:22Portal Hypertension