The recent reduction in mortality from bleeding oesophageal varices is primarily observed from Days 1 to 5
Article first published online: 24 NOV 2009
© 2009 John Wiley & Sons A/S
Volume 30, Issue 3, pages 455–462, March 2010
How to Cite
Hobolth, L., Krag, A. and Bendtsen, F. (2010), The recent reduction in mortality from bleeding oesophageal varices is primarily observed from Days 1 to 5. Liver International, 30: 455–462. doi: 10.1111/j.1478-3231.2009.02169.x
- Issue published online: 18 JAN 2010
- Article first published online: 24 NOV 2009
- Received 7 June 2009Accepted 20 October 2009
- Baveno IV;
- oesophageal varices;
Background: Several new treatments of bleeding oesophageal varices (BOV) have been introduced during the last 25 years; among these are vasoactive drugs, improved endoscopic techniques and prophylactic antibiotics.
Aims: The aim was to compare clinical outcomes based on Baveno IV criteria in two patient-cohorts (1983–1987, n=56 and 2000–2007, n=111) with respect to control of bleeding, rebleeding and mortality after a first episode of BOV. Further, we wanted to assess whether an eventual reduction in bleeding-related mortality occurred within the first 5 days or between Days 6 and 42 after the bleeding episode.
Methods: Data from medical records were collected, according to the Baveno IV criteria, on key events: type of treatment, failure to control bleeding, failure to prevent rebleeding, 5-day and 6-week mortality.
Results: Six-week mortality decreased from 30.4 to 17.1% [odds ratio (OR) 0.44; 0.21–0.95] with a reduction in 5-day mortality from 17.9 to 6.3% (OR 0.31; 0.11–0.86). A non-significant reduction was seen in the 5-day failure rate to control bleeding from 35.7 to 26.1%. Mortality and failure to prevent rebleeding Days 6–42 decreased from 15.2 to 11.5% (NS) and 22.2 to 10.7% (NS) respectively. Mean length of hospital stay decreased from 14.6 ± 12.5 to 9.1 ± 9.0 days (P<0.01) and mean number of cumulated blood transfusions within the first 5 days decreased from 5.0 ± 4.8 to 3.6 ± 3.9 (P=0.05).
Conclusions: In this retrospective study on individual patient records, we observed a decrease in mortality from BOV over the last 20 years, which seems mainly owing to a reduction in 5-day mortality; mortality at Days 6–42 remained unaffected.