Objective: To find and analyse the associated determinants of mortality in admitted patients in cirrhotic patients with MELD score >18 presenting in emergency department with variceal bleeding.
Study design: Cross-sectional study.
Place and duration of study: Department of Emergency Medicine, King Sultan Military Hospital Riyadh, Kingdom of Saudi Arabia, from July 2017 to January 2018.
Methodology: A total of 235 patients fulfilling the inclusion criteria were enrolled in the study. Diagnosis of cirrhosis was made if the patients had platelets <150000/μl, PT >3 sec (prolonged), biochemical (reversal of ALT, AST ratio, albumin <3.5 g/dl) and ultrasongraphic coarse echotexture of liver and splenomegaly; and presence of all of the above variables and for at least six months. Variceal bleeding diagnosed on presentation and emergency endoscopy. MELD score was calculated by following formula. MELD = 3.78 [Ln serum bilirubin (mg/dL)] +11.2 [Ln INR] +9.57 [Ln serum creatinine (mg/dl)] +6.430 NR. Outcome of patients treatment was to record associated morbidity and mortality during follow-up period of one month.
Results: There were 156 (66.4%) male and 79 (33.6%) female cirrhotic patients. The mean age was 47.8 ±8.7 years. Out of 235 patients of liver cirrhosis, 47 (20.0%) expired during the hospital stay, while 188 (80.0%) patients survived and discharged from the hospital. Most of the cirrhotic patients were experienced with MELD score 18-20, i.e. 144 (61.3%) followed by 70 (29.8%) in 21-25 and 21 (8.9%) had the range of 26-30. In-hospital mortality rate was statistically insignificant (p>0.05) with respect to MELD scores. Probability of survival was 0.80.
Conclusion: Liver cirrhosis with MELD score >18 and variceal bleeding is highly prevalent in young adult patients, more likely in male patients having duration of disease since >1 year to 3 years such that every 1 of 5 patients expired during the hospital stay. Probability of survival was 80%.