Recurrent variceal bleeding in cirrhotic patients with acute kidney injury

Document Type : Original Article

Authors

1 internal medicine department faculty of medicine zagazig university

2 physiology department,faculty of medicine,Zagazig university

3 Internal Medicine department, faculty of medicine,Zagazig university

Abstract

Introduction: Patients with liver cirrhosis and presented with bleeding esophageal varices are at higher risk for development of acute kidney injury (AKI) that in turn has negative impacts and bad prognosis.
Aim of the study: We aimed to figure out the association between recurrent esophageal variceal bleeding and presence of AKI in patients with liver cirrhosis.
Methods: Our study included 203 cirrhotic patients divided into 2 groups according to absence or presence of AKI. All patients had full history taking, clinical and laboratory investigations. All patients were managed by fluid resuscitation, vasopressor agents and endoscopic management. The both groups were followed to assess the rate of esophageal variceal re bleeding.
Results: The number of patients who developed AKI was 91 (45 %) and many factors as; low systemic blood pressure, high volume of blood transfusion and high child pugh score were independent predictors for AKI. Factors like Child-Pugh scores (p = 0.006), active bleeding at endoscopy (p = 0.04), and the occurrence of AKI (p = 0.049) were independent predictors of 72h and 1-month variceal rebleeding. The variceal rebleeding rate among patients with AKI was 27.5%, 16.5% and 12.1% at 72 hours, 1 month, 3 months respectively compared to 9%, 5,4% and 4.5% in patients without AKI. At 1st 72 hours, the rate of esophageal variceal rebleeding was higher with more progressive stage of AKI.
Conclusion: The incidence of recurrent esophageal variceal bleeding was higher in patients with liver cirrhosis who developed AKI.
Keywords:
Ascites - Renal failure - Hematemesis

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Zagazig University Medical Journal
Volume 29, Issue 6
November and December 2023
Pages 1482-1490

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