- Title
- Short- and long-term outcomes for patients with variceal haemorrhage in a tertiary hospital
- Creator
- Halland, M.; Ansley, S. J.; Stokes, B. J.; Fitzgerald, M. N.; Inder, K. J.; Duggan, J. M.; Duggan, A.
- Relation
- Internal Medicine Journal Vol. 43, Issue 3, p. 234-239
- Publisher Link
- http://dx.doi.org/10.1111/imj.12037
- Publisher
- Wiley-Blackwell Publishing Asia
- Resource Type
- journal article
- Date
- 2013
- Description
- Background/Aim: To determine short- and long-term outcomes among a cohort of patients with variceal haemorrhage at a tertiary referral centre, and to determine the predictive value of the model for end-stage liver disease (MELD) score for mortality in these patients. Methods: Prospective database hospital audit that captured patients who presented with or were transferred with variceal haemorrhage between 2004 and 2008, and a retrospective review of long-term outcomes. Patients who presented to or were transferred to John Hunter Hospital, a tertiary referral hospital, with confirmed variceal bleeding were included. The main outcome measures were in-hospital, 6 weeks and end-of-audit mortality. We also recorded cause, location and degree of planning surrounding the deaths in this patient group. We analysed the MELD score for patients with complete survival data. Results: We recorded 93 episodes of variceal haemorrhage from 78 unique patients during the initial study period. The in-hospital mortality, 6 weeks mortality and end-of-audit mortality were 2.6, 9.0 and 59, respectively, and median survival time was 3.2 years (95% confidence interval 0.0, 6.1). The most frequent cause of death was related to complications of end-stage liver disease at 74%, followed by variceal bleeding (19%) and unknown (6%). A Cox proportional hazard model showed that the risk of mortality is increased by 1.06 (1.01–1.11) for each unit increase in MELD score. Conclusions: Short-term outcomes for patients with variceal bleeding continue to improve, but long-term prognosis remains guarded and should prompt further emphasis on advanced care planning to optimise patient care.
- Subject
- portal hypertension; variceal haemorrhage; long-term outcomes; epidemiology; advanced care planning; MELD score
- Identifier
- http://hdl.handle.net/1959.13/1299692
- Identifier
- uon:19923
- Identifier
- ISSN:1444-0903
- Language
- eng
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