Improved patient survival after acute variceal bleeding

A multicenter, cohort study

Naga Chalasani, Charles Kahi, Fritz Francois, Amar Pinto, Atul Marathe, Edmund J. Bini, Prashant Pandya, Shanti Sitaraman, Jianzhao Shen

Research output: Contribution to journalArticle

298 Citations (Scopus)

Abstract

OBJECTIVE: Existing literature indicates that the mortality rate with each variceal bleeding episode is 30-50%. Over the past 2 decades, there have been significant developments in the management of variceal bleeding. The effect of these developments on the natural history of variceal bleeding is unclear. Therefore, a retrospective, multicenter study was conducted to define the outcomes of variceal bleeding and to describe the patterns of current practice in the management of variceal bleeding. METHODS: All patients with documented variceal bleeding hospitalized at four large county hospitals from January 1, 1997, to June 30, 2000, were included. Study outcomes were in-hospital, 6-wk, and overall mortality, rate of rebleeding, transfusion requirement, and length of stay. After discharge, patients were followed until death or study closure date, on June 30, 2000. RESULTS: A total of 231 subjects were included, and their in-hospital, 6-wk, and overall mortality rates were 14.2%, 17.5%, and 33.5%, respectively. The frequency of rebleeding during follow-up was 29%. Median length of total hospital stay was 8 days (0-34 days). Median number of packed red cell units transfused was 4 U (0-60 U). Upper endoscopy was performed in 95% of patients within 24 h, and endoscopic therapy was done in all but eight patients (ligation 64%, sclerotherapy 33%). Octreotide was administered in 74% of the patients. Portasystemic shunts were performed in 7.5% of the patients for controlling acute variceal bleeding. CONCLUSIONS: The mortality rate after variceal bleeding in this study was substantially lower than previously reported. This suggests that advances made in the management of variceal bleeding have improved outcomes after variceal bleeding.

Original languageEnglish
Pages (from-to)653-659
Number of pages7
JournalAmerican Journal of Gastroenterology
Volume98
Issue number3
DOIs
StatePublished - Mar 1 2003

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Multicenter Studies
Cohort Studies
Hemorrhage
Survival
Mortality
Length of Stay
Surgical Portasystemic Shunt
County Hospitals
Sclerotherapy
Octreotide
Practice Management
Natural History
Endoscopy
Ligation
Retrospective Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Improved patient survival after acute variceal bleeding : A multicenter, cohort study. / Chalasani, Naga; Kahi, Charles; Francois, Fritz; Pinto, Amar; Marathe, Atul; Bini, Edmund J.; Pandya, Prashant; Sitaraman, Shanti; Shen, Jianzhao.

In: American Journal of Gastroenterology, Vol. 98, No. 3, 01.03.2003, p. 653-659.

Research output: Contribution to journalArticle

Chalasani, Naga ; Kahi, Charles ; Francois, Fritz ; Pinto, Amar ; Marathe, Atul ; Bini, Edmund J. ; Pandya, Prashant ; Sitaraman, Shanti ; Shen, Jianzhao. / Improved patient survival after acute variceal bleeding : A multicenter, cohort study. In: American Journal of Gastroenterology. 2003 ; Vol. 98, No. 3. pp. 653-659.
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abstract = "OBJECTIVE: Existing literature indicates that the mortality rate with each variceal bleeding episode is 30-50{\%}. Over the past 2 decades, there have been significant developments in the management of variceal bleeding. The effect of these developments on the natural history of variceal bleeding is unclear. Therefore, a retrospective, multicenter study was conducted to define the outcomes of variceal bleeding and to describe the patterns of current practice in the management of variceal bleeding. METHODS: All patients with documented variceal bleeding hospitalized at four large county hospitals from January 1, 1997, to June 30, 2000, were included. Study outcomes were in-hospital, 6-wk, and overall mortality, rate of rebleeding, transfusion requirement, and length of stay. After discharge, patients were followed until death or study closure date, on June 30, 2000. RESULTS: A total of 231 subjects were included, and their in-hospital, 6-wk, and overall mortality rates were 14.2{\%}, 17.5{\%}, and 33.5{\%}, respectively. The frequency of rebleeding during follow-up was 29{\%}. Median length of total hospital stay was 8 days (0-34 days). Median number of packed red cell units transfused was 4 U (0-60 U). Upper endoscopy was performed in 95{\%} of patients within 24 h, and endoscopic therapy was done in all but eight patients (ligation 64{\%}, sclerotherapy 33{\%}). Octreotide was administered in 74{\%} of the patients. Portasystemic shunts were performed in 7.5{\%} of the patients for controlling acute variceal bleeding. CONCLUSIONS: The mortality rate after variceal bleeding in this study was substantially lower than previously reported. This suggests that advances made in the management of variceal bleeding have improved outcomes after variceal bleeding.",
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AU - Chalasani, Naga

AU - Kahi, Charles

AU - Francois, Fritz

AU - Pinto, Amar

AU - Marathe, Atul

AU - Bini, Edmund J.

AU - Pandya, Prashant

AU - Sitaraman, Shanti

AU - Shen, Jianzhao

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N2 - OBJECTIVE: Existing literature indicates that the mortality rate with each variceal bleeding episode is 30-50%. Over the past 2 decades, there have been significant developments in the management of variceal bleeding. The effect of these developments on the natural history of variceal bleeding is unclear. Therefore, a retrospective, multicenter study was conducted to define the outcomes of variceal bleeding and to describe the patterns of current practice in the management of variceal bleeding. METHODS: All patients with documented variceal bleeding hospitalized at four large county hospitals from January 1, 1997, to June 30, 2000, were included. Study outcomes were in-hospital, 6-wk, and overall mortality, rate of rebleeding, transfusion requirement, and length of stay. After discharge, patients were followed until death or study closure date, on June 30, 2000. RESULTS: A total of 231 subjects were included, and their in-hospital, 6-wk, and overall mortality rates were 14.2%, 17.5%, and 33.5%, respectively. The frequency of rebleeding during follow-up was 29%. Median length of total hospital stay was 8 days (0-34 days). Median number of packed red cell units transfused was 4 U (0-60 U). Upper endoscopy was performed in 95% of patients within 24 h, and endoscopic therapy was done in all but eight patients (ligation 64%, sclerotherapy 33%). Octreotide was administered in 74% of the patients. Portasystemic shunts were performed in 7.5% of the patients for controlling acute variceal bleeding. CONCLUSIONS: The mortality rate after variceal bleeding in this study was substantially lower than previously reported. This suggests that advances made in the management of variceal bleeding have improved outcomes after variceal bleeding.

AB - OBJECTIVE: Existing literature indicates that the mortality rate with each variceal bleeding episode is 30-50%. Over the past 2 decades, there have been significant developments in the management of variceal bleeding. The effect of these developments on the natural history of variceal bleeding is unclear. Therefore, a retrospective, multicenter study was conducted to define the outcomes of variceal bleeding and to describe the patterns of current practice in the management of variceal bleeding. METHODS: All patients with documented variceal bleeding hospitalized at four large county hospitals from January 1, 1997, to June 30, 2000, were included. Study outcomes were in-hospital, 6-wk, and overall mortality, rate of rebleeding, transfusion requirement, and length of stay. After discharge, patients were followed until death or study closure date, on June 30, 2000. RESULTS: A total of 231 subjects were included, and their in-hospital, 6-wk, and overall mortality rates were 14.2%, 17.5%, and 33.5%, respectively. The frequency of rebleeding during follow-up was 29%. Median length of total hospital stay was 8 days (0-34 days). Median number of packed red cell units transfused was 4 U (0-60 U). Upper endoscopy was performed in 95% of patients within 24 h, and endoscopic therapy was done in all but eight patients (ligation 64%, sclerotherapy 33%). Octreotide was administered in 74% of the patients. Portasystemic shunts were performed in 7.5% of the patients for controlling acute variceal bleeding. CONCLUSIONS: The mortality rate after variceal bleeding in this study was substantially lower than previously reported. This suggests that advances made in the management of variceal bleeding have improved outcomes after variceal bleeding.

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