Bleeding Control and Survival After Acute Variceal Bleeding in Patients with Liver Cirrhosis
Acute variceal bleeding (AVB) is a severe complication of patients with liver cirrhosis and portal hypertension. Despite AVB-associated mortality has decreased in the last decades - mainly due improved medical, endosocpic and interventional treatment options, six-week mortality may still be as high as 20%. Higher portal pressure, active bleeding at endoscopy and a high MELD- or Child-Pugh-Score (CPS) present important risk factors for bleeding related mortality. Recent publications have shown that the CPS seems to be the best single predictor for AVB-related complications.
Guidelines for AVB management recommend the early use of vasoactive substances, such as somatostatin or terlipressin, and a transfer to a specialized center where endoscopy and endoscopic variceal band ligation (EBL) can be performed within 12 hours. In the case of gastric varices, glue injection (histoacrylat) represents the first-line treatment. Further, the use of intravenous antibiotics has been shown to be associated not only with a decreased risk of infections but also with improved survival. In secondary prophylaxis a combination of non-selective β-blockers (NSBBs) and regular EBL (until variceal eradication) is recommended. The combination has been reported to be more effective in controlling recurrent variceal bleeding than the respective monotherapies. The recently updated Baveno VI consenus summarizes new guidelines and indicate fields of portal hypertension where more research is needed by well-designed prospective trials.
The outcome of patients treated at the Medical University of Vienna (MUV) has not been systematically assessed. Thus, the goal of this doctoral thesis is to describe the characteristics and treatment modalities of patients with AVB managed at the MUV. In addition, we aim to find predictors for bleeding-related complications and mortality.
For the primary analysis, I will report 5-day and 6-week rebleeding rates, as well as (ii) 6-week and 1-year mortality.
Furthermore, I will assess the influence of (i) antibiotics and hepatic encephalopathy treatment on the outcome of variceal bleeding, (ii) the incidence of acute kidney injury following AVB and (iii) report on the incidence and outcome after rescue treatments for early rebleeding (in case endoscopic treatment fails).
Methods and Skills:
Schwabl P, Hambruch E, Seeland BA, Hayden H, Wagner M, Garnys L, Strobel B, Schubert TL, Riedl F, Mitteregger D, Burnet M, Starlinger P, Oberhuber G, Deuschle U, Rohr-Udilova N, Podesser BK, Peck-Radosavljevic M, Reiberger T, Kremoser C, Trauner M. The FXR agonist PX20606 ameliorates portal hypertension by targeting vascular remodelling and sinusoidal dysfunction. J Hepatol 66: 724-733, 2017