CLINICAL RESULTS IN PATIENTS WITH GASTROESOPHAGEAL VARICEAL BLEEDING IN THE ICU: ANALYSIS OF 85 CASES IN A TERTIARY CARE CENTRE

Introduction and Objectives

Variceal bleeding represents a challenge in the intensive care unit (ICU). This study describes the experience at a tertiary care center, evaluating clinical characteristics, the impact of early endoscopy (<12 hours), transfusion requirements, complications, and 6-week mortality.

Patients and Methods

Retrospective study of 85 patients with portal hypertension and gastroesophageal variceal bleeding admitted to the ICU between 2023 and 2024, all of whom underwent endoscopic intervention within 12 hours. Clinical variables, type of endoscopic therapy, bleeding control, transfusion requirements, ICU length of stay, rebleeding, infectious complications, and mortality were analyzed. Descriptive statistics, chi-square tests, and survival analysis were performed using SPSS.

Results

281 endoscopies for gastrointestinal bleeding, 85 were due to variceal bleeding. Mean age was 64.14 years, 58.8% were male. Banding was performed in 85.9% of cases. Initial bleeding control was achieved in 92.9% of patients. Rebleeding occurred in 58.8%, and 6-week mortality was 18.8%, predominantly in patients with more advanced liver dysfunction (Child-Pugh score C, p<0.0001). The mean number of blood units transfused was 1.59. Patients who received more than 6 units had significantly higher mortality (68% vs. 13%, p<0.002) and longer ICU stays (p<0.004). Infections occurred in 21.2% of patients and were associated with increased rebleeding (p<0.014) and higher mortality (p<0.001).

Conclusions

Early endoscopy is effective in achieving initial hemostasis, but prognosis remains poor in patients with advanced liver dysfunction. Massive transfusion and infectious complications are associated with worse outcomes. Early supportive care optimization and consideration of preemptive TIPS should be part of the management strategy.

Conflict of interest: None

Table 1. Patient characteristics (n=85)

Age, years (mean +DE)	64.14 DE 1.1
Male sex, n (%)	50 (58,8)
Child-Pugh score at admission, n (%)
Child A	24 (27.9)
Child B	36 (41.9)
Child C	25 (29.1)
Endoscopic band received, n (%)
Endoscopic band ligation	73 (85.9)
Sclerotherapy	8 (9.4)
Other	3 (3.5)
Initial bleeding control, n (%)
Yes	79 (92.9)
No	6 (7.1)
Rebleeding, n (%)
Yes	50 (58.8)
No	35 (41.2)
ICU stay, days (mean +DE)	3.75 (DE 6.57)
Red blood cell units transfused, mean +DE	1.59 (1.73)
6-week mortality, n (%)
Yes	16 (18.8)
No	69 (81.2)
Complications, n (%)
Hepatic encephalopathy	24 (28.2)
infection	18 (21.2)
Shock	21 (24.7)

6-week mortality