Variceal Bleeding has Increased Mortality Compared to Non-Variceal Bleeding only in Males.

Question Gastrointestinal bleedings (GIB) are frequent in cirrhotic patients and lead to high morbidity and mortality. Lately, there have been conflicting reports on the role of and bleeding type (variceal bleeding [VB] and non-variceal bleeding [NVB]).

This study investigated predictors of mortality in patients with VB and NVB with relationship to sex differences.

Methods 271 patients with suspected upper GIB who underwent endoscopy were included. Patients were followed up at one week, six months and one year after admission. Uni– and multivariate logistic or Cox regression analyses investigated correlations of predictive factors and clinical outcomes. Propensity score matching was performed to control for severity of disease and compare groups for sex and bleeding type.

Results 42 patients were excluded (cirrhosis or bleeding not confirmed). The remaining patients were classified by bleeding type into patients with VB (n = 115) or NVB (n = 156). Males (n = 155) had a higher mortality in VB than in NVB, while in females (n = 116) mortality was similar in the two bleeding types. This was confirmed after matching in males (n = 116) and females (n = 82). Further independent predictors of mortality in males were MELD at baseline, BUN, ALT, while in females age, leukocytes, MELD, history of ascites and hepatic encephalopathy.

Conclusion This study shows that VB has higher mortality in males compared to NVB, while in females the type of GIB does not impact outcome.

Publication History

Article published online:
04 January 2021