Clinical Features And Prognostic Factors Analysis Of Cirrhotic Patients With Upper Gastrointestinal Bleeding

Objective：This study was designed to describe the clinical features，evaluatethe complications，treatment outcomes and identify the risk factors forprognosis in cirrhotic patients with upper gastrointestinal (UGI) bleeding.Sowe can get deeper recognization and treatment guiding.Methods：This study retrospectively reviewed the records of246cirrhoticpatients with UGI bleeding in FUJIAN Medical University union Hospital fromOctober2009to September2012.Results：①In the whole series,197(80.1%) out of246episodes occurred inmales.Single HBV infection was the most frequent etiology（65.4%）.Thesource of bleeding was esophagogastric varices in74.0%ofpatients,nonvariceal lesions in12.2%. Alcoholic cirrhotic patients tended todevelop massive bleeding（χ~2=8.54，p=0.014）.②There were27patients（11.0%） with encephalopathy.The factors of encephalopathy werebilirubinl，albumin，INR，Child-Pugh class，AST and ALT on admission to thehospital.A total of79patients （32.1%） were infected.Pneumonia wasobserved frequently.The use of prophylactic antibiotics decreased theincidence of hospital infections in cirrhotic patients with UGI bleeding（χ~2=4.39，p=0.036）.③The five-day mortality rate was4.9%,the cause ofdeath was failure to control bleeding.The mortality rate was9.0%during days6-42, the cause of death were failure to control bleeding，encephalopathyand infection.After means of univariate，using multivariate logistic analysis：vomiting blood before hospital，bilirubin on admission to the hospital andencephalopathy during hospital were the independent predictors ofdeath.Conclusions：①Alcoholic cirrhotic patients tended to develop massivebleeding.②Severe hepatic dysfunction was the factor of encephalopathy.The use of prophylactic antibiotics decreased the incidence of hospital infectionsin cirrhotic patients with UGI bleeding.③The cause of death in the acutebleeding episode was failing to control bleeding. With the development ofdisease,the number patients who died form encephalopathy and infectionincreaseed.Vomiting blood before hospital，bilirubin on admission to thehospital and encephalopathy during hospital were the independentpredictors of death.