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Excerpt
Introduction: Garden [1] and Gatta [2] have proposed equations to predict outcome in patients with liver cirrhosis and gastrointestinal bleeding (GIB). In an earlier retrospective study, we showed these prognostic indices are not superior to the APACHE II system. [3] We undertook this study to validate these observations prospectively.
Methods: This prospective, observational study included 111 hospitalizations of 85 patients with hepatic cirrhosis admitted for GIB from 1/1/95 through 6/30/97. Data collected included demographics, the presence of encephalopathy and ascites, selected laboratory values, cause of the GIB and in-hospital mortality. The Child-Pugh scores and the predicted mortalities based on APACHE II. Gatta's and Garden's prognostic systems were calculated. Student's t. Mann-Whitney U and chi-square tests were used to determine differences between groups.
Results: Eighty-six (77%) patients were male, 73(66%) Caucasian, 32(29%) African-American, 3 Native American and 1 Asian. The patients' mean +/- SD age was 48.7 +/- 9.6 years. There was evidence of encephalopathy in 19(17%) and ascites in 57(51%). The 2 most common causes of the GIB were varices(64) and peptic ulcer disease(8). Seventy-nine(71%) Patients were admitted to an Intensive Care Unit (ICU). None of the 18 patients with Child class A died compared to 15%(7/48) in class B and 36%(16/45) in class C (P=0.0027). Sex and race were not associated with mortality. The actual and predicted in-hospital mortality rates were: Table 1
Conclusions: The prognostic indices designed specifically for patients with hepatic cirrhosis and GIB are superior to APACHE II in predicting the in-hospital mortality rates of such patients admitted to ICU.
