Vasoactive Medications for the Treatment of Acute Variceal Bleeds: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Purpose: Vasoactive medications such as vasopressin, somatostatin and their analogues are commonly used for the treatment of acute variceal bleeds. We undertook a systematic review to determine the impact of vasoactive agents on mortality, transfusion requirements, rebleeding, arrest and control of bleeding and duration of hospital stay in patients having variceal bleeds. Methods: We included randomized controlled trials (RCTs) of vasopressin, somatostatin and their analogues, administered to patients with acute variceal bleeds. We systematically searched nine electronic databases and examined multiple sources of grey literature for eligible trials. Two independent investigators assessed trial eligibility and abstracted data. Results: Our search identified 2978 citations, and 28 trials with 2444 patients met our eligibility criteria. Acute mortality rate within 7 days was 77/856 patients in the vasoactive agents vs. 102/843 patients in the control group (RR 0.76; 95% CI 0.58-1.00; p=0.05; I2=0%; moderate quality of evidence). Intermediate mortality rate (15-42 days) was 140/676 patients in the vasoactive agents vs. 181/678 patients in the control group (RR 0.80; 95% CI 0.64-1.00; p=0.05; I2=21%; moderate quality of evidence). Arrest of bleeding was obtained in 649/875 patients in the vasoactive agents group vs. 512/855 patients in the control group (RR 1.20; 95% CI 1.12-1.29; p<0.00001; I2=28%; very low quality of evidence). Transfusion requirements were lower in patients treated with vasoactive agents compared with patients in the control group (pooled mean difference -0.70 units of blood transfused, 95% CI -1.01 to -0.38; P<0.00001; I2=82%; moderate grade of evidence). Patients treated with vasoactive agents had a shorter hospital stay (mean difference -0.71 days; 95% CI -1.23 to -0.19; p=0.007; I2=0%; low grade of evidence).Table: Summary of findings: vasoactive agents for treatment of variceal hemorrhageFigure: Forest plot of acute all-cause mortality.Conclusion: In patients suffering an acute variceal bleed, a significantly lower rate of acute all-cause mortality, intermediate all-cause mortality, and transfusion requirements, as well as improved control of bleeding and shorter hospital stay was found in patients randomized to vasopressin, somatostatin and their analogues.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.029 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.019 | 0.028 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".