Hospitalization for variceal hemorrhage in an era with more prevalent cirrhosis

Abstract

Aim: To examine hospitalization rates for variceal hemorrhage and relation to cause of cirrhosis during an era of increased cirrhosis prevalence.

Methods: We performed a retrospective review of patients with cirrhosis and gastroesophageal variceal hemorrhage who were admitted to a tertiary care referral center from 1998 to 2009. Subjects were classified according to the etiology of their liver disease: alcoholic cirrhosis and non-alcoholic cirrhosis. Rates of hospitalization for variceal bleeding were determined. Data were also collected on total hospital admissions per year and cirrhosis-related admissions per year over the same time period. These data were then compared and analyzed for trends in admission rates.

Results: Hospitalizations for cirrhosis significantly increased from 611 per 100000 admissions in 1998-2001 to 1232 per 100000 admissions in 2006-9 (P value for trend < 0.0001). This increase was seen in admissions for both alcoholic and non-alcoholic cirrhosis (P values for trend < 0.001 and < 0.0001 respectively). During the same time period, there were 243 admissions for gastroesophageal variceal bleeding (68% male, mean age 54.3 years, 62% alcoholic cirrhosis). Hospitalizations for gastroesophageal variceal bleeding significantly decreased from 96.6 per 100000 admissions for the time period 1998-2001 to 70.6 per 100000 admissions for the time period 2006-2009 (P value for trend = 0.01). There were significant reductions in variceal hemorrhage from non-alcoholic cirrhosis (41.6 per 100000 admissions in 1998-2001 to 19.7 per 100000 admissions in 2006-2009, P value for trend = 0.007).

Conclusion: Hospitalizations for variceal hemorrhage have decreased, most notably in patients with non-alcoholic cirrhosis, and this may reflect broader use of strategies to prevent bleeding.

Keywords: Cirrhosis; Gastrointestinal bleeding; Hospitalization; Portal hypertension; Varices.

Figure 1

Mean model of end stage liver disease scores for study population per year. P value = 0.20 reflects trend for MELD scores for cirrhosis of all causes. P value = 0.27 reflects comparison of ALC and NALC groups. MELD: Model for end-stage liver disease; All: Cirrhosis all causes; ALC: Alcoholic cirrhosis; NALC: Non-alcoholic cirrhosis.

Figure 2

Admissions with cirrhosis per 100000 IP visits based on etiology of cirrhosis. P values are for trend. All: Cirrhosis all causes; ALC: Alcoholic cirrhosis; NALC: Non-alcoholic cirrhosis.

Figure 3

Trends in admissions for variceal bleeding per 100000 inpatient visits based on etiology of cirrhosis. A: Total variceal bleeds; B: Index variceal bleeds; C: Variceal rebleeding. P values are for trend during study period. All: Cirrhosis all causes; ALC: Alcoholic cirrhosis; NALC: Non-alcoholic cirrhosis.

Figure 4

Transjugular intrahepatic portosystemic shunt placement 1998-2009. P values are for trend. TIPS: Transjugular intrahepatic portosystemic shunt; GI: Gastrointestinal.

Figure 5

Hospital deaths per 100000 admissions based on etiology of cirrhosis. P value is for trend. All: Cirrhosis all causes; ALC: Alcoholic cirrhosis; NALC: Non-alcoholic cirrhosis.

Figure 6

Non-selective beta-blocker usage amongst patients with variceal index bleeding and recurrent variceal bleeding. NSBB: Nonselective beta-blocker. P values are for trend.