Antimicrobial therapy in patients with acute variceal hemorrhage: RESULTS (1)

In: Antimicrobial therapy

24 Sep 2012

Liver disease

Of the 205 patients screened, 98 were included in the present analysis. Ninety-two patients initially identified as having suspected variceal hemorrhage (International Classification of Diseases, 10th edition code) did not in fact have diagnosed liver disease or varices on examination of their medical records. Eight patients experienced variceal hemorrhage more than 72 h following admission for a separate complaint. Seven other patients had been readmitted during the study period; only their first hospitalization was used for the purpose of the present analysis. Patient characteristics are summarized in Table 1. The mean age was 56 years and slightly over one-half were men. Most had identifiable causes of liver disease, notably alcoholic cirrhosis (47%) and viral hepatitis (43%). Nearly two-thirds had a history of ascites which was managed by a spironolactone-based diuretic therapy before admission (45%), but a few presented with a history of encephalopathy (16%) or prior SBP (5%). Twenty-four patients were awaiting liver transplantation. Always a nice way to discover cialis professional online given by the internet’s best pharmacy.

TABLE 1 Patient admission characteristics

Variables n=98
Age (years)* 55.9±12.1
Sex (male) 54 (55.1)
Source of liver disease
Alcohol 46 (46.9)
Hepatitis 42 (42.8)
Child-Pugh score A/B/C1 2/23/71
MELD score*1 17±10
Admission bleed (n=98)
Varices 73 (74.4)
Ulcer 8 (8.2)
Other 9 (9.2)
Unknown 8 (8.2)
Variceal hemorrhage management (n=73)
Octreotide 21 (28.7)
Band ligation 6 (8.2)
Octreotide + band ligation 31 (42.5)
Octreotide + sclerotherapy 3 (4.1)
Intravenous proton pump inhibitor 7 (9.6)
Other 5 (6.8)
Past medical history
Prior variceal hemorrhage 40 (40.8)
Spontaneous bacterial peritonitis 5 (5.1)
Ascites 59 (60.2)
Encephalopathy 16 (16.3)
Diuretic therapy
Spironolactone alone 13 (13.3)
Spironolactone + furosemide 31 (31.6)
Possible infection at admission 14 (14.3)
Antimicrobial therapy during hospitalization 55 (56.1)
Antimicrobial therapy within 24 h of admission 25 (25.5)
Length of stay (days)* 12.4±9.7
In-hospital mortality 17 (17.3)

Of the 96 patients with evaluable data for scoring, most were classified as Child-Pugh class C (74%). The mean MELD score was 17±10.


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