Portal hypertensive bleeding independently predicts mortality in patients hospitalized for alcoholic hepatitis with gastrointestinal bleeding

Abstract

Introduction: Gastrointestinal bleeding (GIB) is often accompanied by patients with alcoholic hepatitis (AH). The aims of the present study were 1) to identify the etiologies of GIB in patients hospitalized for AH

2) to investigate the clinical characteristics and long-term survival outcomes of patients hospitalized for AH according to the presence or absence of GIB

3) to identify factors associated with long-term mortality. Methods: A hospital-based, retrospective cohort comprised consecutive patients who were hospitalized for AH between 1999 and 2014. Those patients were dichotomized into two groups: those who experienced GIB once or more (GIB group) and those who never experienced GIB till death or censoring (Non-GIB group). GIB group was dichotomized into another two groups: those whose bleeding focus of the 1st GIB was found to be portal hypertensive bleeding (PHB group) and those of non-portal hypertensive bleeding (Non-PHB group). Clinical characteristics and long-term survival outcomes of patients hospitalized for AH according to the presence or absence of GIB and PHB were investigated. Risk factors for long-term mortality in AH patients were also analyzed using the Cox regression method. Results: A total of 329 patients hospitalized for AH were included in this study. Among them, 132 patients experienced GIB at admission or during follow up. Of the 132 patients, the most common cause of GIB was esophageal varix. Using the log rank test, GIB group had worse survival outcome compared with Non-GIB group (log rank test, p=0.034). PHB group had worse survival outcome compared with the Non-PHB group (log rank test, p=0.001). There was no significant difference in survival rate between the Non-PHB group and Non-GIB group. In the multivariable analysis of all AH patients, alcohol dose, ascites, encephalopathy, Maddreys discriminant function (MDF) and the model for end-stage liver disease (MELD) were associated with mortality. In the multivariable analysis of GIB group, MELD score (HR, 1.094

95% CI, 1.063-1.127

P<0.001) and the presence of PHB (HR, 2.178

95% CI, 1.023-4.634

P=0.043) were found to be independently associated with mortality. Conclusions: Portal hypertensive bleeding and high MELD scores independently predicted worse survival outcomes in AH patients with gastrointestinal bleeding. Therefore, the prompt endoscopic examination may help physicians to stratify the risk of mortality in AH patients with GIB.