Comparison of outcomes between variceal and non-variceal gastrointestinal bleeding in patients with cirrhosis: Insights from a Nationwide Inpatient Sample

Authors Umer Farooq, Zahid Ijaz Tarar, Diana Franco, Faisal Kamal, Ayokunle T. Abegunde.


Background Variceal upper gastrointestinal bleeding (VUGIB) occurs in patients with decompensated cirrhosis, but non-VUGIB (NVUGIB) is not uncommon. We compared the outcomes of VUGIB and NVUGIB in cirrhotic patients.

Methods This retrospective study used Nationwide Inpatient Sample employing International Classification of Diseases codes for adult NVUGIB and VUGIB patients. Mortality, morbidity, and resource utilization were compared. Analyses were performed using STATA; proportions and continuous variables were compared using Fisher’s exact and Student’s t-test, respectively. Confounding variables were adjusted using propensity matching, multivariate logistic and linear regression analyses.

Results Of 2,166,194 cirrhotics, 92,439 had a diagnosis of NVUGIB and 17,620 VUGIB. VUGIB patients had higher rates of mortality [adjusted odds ratio (aOR) 1.42, 95% confidence interval (CI) 1.19-1.69], hemorrhagic shock (aOR 1.84, 95%CI 1.54-2.17) and intensive care unit admission (aOR 2.47, 95%CI 2.18-2.81), greater hospitalization costs ($16,251 vs. $12,295, P<0.001), more need for packed red blood cell transfusion (aOR 1.12, 95%CI 1.03-1.22) or endoscopic therapy (aOR 2.71, 95%CI 2.47-2.93), and a longer hospital stay compared to NVUGIB. However, NVUGIB had higher aOR of undergoing diagnostic endoscopy and radiography-guided vessel embolization. There were no differences in the rates of acute kidney injury between the 2 groups. Ascites and spontaneous bacterial peritonitis were independently associated with increased VUGIB mortality.

Conclusions VUGIB in patients with cirrhosis is associated with greater hospital costs, mortality, and morbidity burden than NVUGIB. This study provides updated and current knowledge of patient characteristics and differences in outcomes between VUGIB and NVUGIB, required to successfully address the healthcare delivery gaps.

Keywords Liver cirrhosis, treatment outcome, gastrointestinal hemorrhage, mortality, morbidity

Ann Gastroenterol 2022; 35 (6): 618-626