Re-Bleeding in Patients With Cirrhosis: Evaluation of Esophageal and Gastric Variceal Bleeding and Their Relationship With a Model for theEnd-Stage Liver Disease (MELD) Score and Child-Pugh Score

Background: Variceal bleeding is one of the leading causes of mortality in patients with cirrhosis. Child-pugh (CP) score and model forthe end-stage liver disease (MELD) score systems are the two main methods for predicting the complications and mortality of cirrhosis;however, none of these methods has been definitively superior to the other. Objectives: In this study we compare and determine these scores in both groups of patients with esophageal and gastric variceal bleeding.Furthermore, re-bleeding rate in these two groups will be studied and compared. Patients and Methods: In this cohort study all patients with upper gastrointestinal bleeding chief complaint referred to the emergencyward of Imam Reza Hospital, Mashhad, Iran from April 2012 to April 2013 were enrolled. Then patients distributed in to two groups ofesophageal and gastric variceal bleeding based on the endoscopic results. Finally the relationship between different clinical andparaclinical variables and bleeding rate in these two groups compared by means of Child-Pugh and MELD scores. T-test, χ2 test, and theKruskal-Wallis test were used for analysis by means of SPSS 17.0 for Windows. Data were expressed as mean ± standard deviation and P<0.05 was considered to be significant. Results: Among 34 understudied patients, 12 patients (8 males) had gastric varices and 22 patients (15 males) had esophageal varices. Nosignificant difference between these two groups was observed. Two patients (5.8%) including 1 patient with gastric varices and 1 patientwith esophageal varices had re-bleeding before six weeks; also 8 patients (23.5%) including 3 patients were also reports with gastric varicesand 5 patients with esophageal varices had re-bleeding after six weeks. Fisher s exact test showed that there is no statistically significantrelationship between the re-bleeding and the disease groups (P value = 0.098). The results showed that there is no difference between thevariable levels in both groups. Conclusions: The level of two CP and MELD scores and their individual variables in two groups of patients with esophageal and gastricvarices bleeding were not significantly different. On the other hand, re-bleeding rate was not different between these two groups.

Keywords:

Liver Diseases , Esophageal and Gastric Varice , Bleeding