A57 ACUTE VARICEAL GASTROINTESTINAL BLEEDING DOES NOT INFER POOR SURVIVAL COMPARED TO NON-VARICEAL BLEEDING IN PATIENTS WITH CIRRHOSIS: A RETROSPECTIVE, OBSERVATIONAL STUDY

Acute upper gastrointestinal bleed (UGIB) in cirrhosis is associated with significant morbidity and mortality. The most frequent cause of UGIB in cirrhosis is acute variceal bleed (AVB), though non-variceal bleed (NVB) may also occur. Whether there exists differences in mortality and clinical outcomes between AVB and NVB is unknown. To evaluate differences in clinical outcomes, such as mortality, intensive care unit (ICU) stay, and need for transfusion between AVB and NVB in patients with cirrhosis presenting with UGIB. All patients over the age of 18 with cirrhosis who presented to The Ottawa Hospital with UGIB and underwent upper endoscopy were included. AVB was defined as presence of varices on endoscopic examination with at least high-risk stigmata such as cherry-red spots or red-wale markings. NVB was defined as other etiology of UGIB such as peptic ulcer disease, portal hypertensive gastropathy, esophagitis, and dieulafoy lesions. The primary outcome was the risk of mortality of AVB and NVB in cirrhotic patients presenting with UGIB. We also compared hospital length of stay (LOS), 30-day hospital readmission, ICU admission, requirement for transfusion, and baseline characteristics such as demographics, cirrhosis complications, and presenting laboratory investigations between the two groups. Descriptive statistics were calculated using chi-square test and t-test with R v3.3. From 2014–2016, a total of 117 patients with cirrhosis were admitted with UGIB, 75 with AVB and 42 with NVB. The median age in the AVB group was 54.69 compared to 60.64 in the NVB group (p=0.001). There were no significant differences in gender or active alcohol use in both groups. The median model of end-stage liver disease (MELD) score was not significantly different in the AVB group (15.13, IQR 11.03–17.60) vs. the NVB group (15.09, IQR 10.92–23.21) (p=0.649). The risk of mortality was 13.3% in the AVB group compared to 9.5% in the NVB group (p=0.543). There was no significant difference in ICU admission (29.3% for AVB vs. 16.7% for NVB, p=0.128) or need for transfusion (65.3% for AVB vs. 54.8% for NVB, p=0.26). Patients who had AVB were more likely to have a history of previous esophageal varices (62.7%) compared to those who presented with NVB (38.1%) (p=0.011). There were no differences in history of hepatic encephalopathy, spontaneous bacterial peritonitis, and ascites in both groups. Hospital LOS was not significantly different for the AVB group (4.95, IQR 3.65–6.90) and NVB group (5.05, IQR 2.65–8.59) (p=0.42). Our results found no difference in mortality, hospital LOS, and need for ICU between AVB and NVB. A history of known esophageal varices may predict future AVB whereas an older age may predict NVB in cirrhosis. None

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