Improved clinical outcomes of patients with cirrhosis and acute variceal bleeding over the last 2 decades.

BACKGROUND AND AIMS: Acute variceal bleeding (AVB), a severe adverse event of portal hypertension, may cause death in patients with cirrhosis. We investigated whether outcomes after AVB have improved over time.

METHODS

Data from 406 patients with cirrhosis with AVB (2000-2022) from 2 Viennese centers were analyzed for recurrent bleeding, 6-week mortality, and 1-year transplant-free survival.

RESULTS

Recurrent bleeding rates within 6 weeks decreased from 19.4% to 11.8% (hazard ratio [HR], 0.59; 95% CI, 0.35-0.97; P = .049) and bleeding-related mortality decreased from 23.6% to 18.3% (HR, 0.68; 95% CI, 0.44-1.06; P = .099). One-year transplant-free survival after AVB improved from 63.8% to 73.7% (HR, 0.68; 95% CI, 0.47-0.97; P = .041). Higher Child-Pugh scores were associated with increased risk for bleeding (adjusted odds ratio [aOR], 1.68) and mortality (aOR, 1.69; both P < .001). Nonselective beta-blockers reduced 1-year mortality risk (aOR, 0.48; P = .038).

CONCLUSIONS

Recurrent bleeding and mortality rates after AVB improved over the last 2 decades but remain substantial, highlighting the need for continued efforts to optimize outcomes for patients with cirrhosis.