Comparison of clinical outcomes in cirrhotic patients presenting with acute variceal and nonvariceal gastrointestinal bleeding

BACKGROUND/AIMS: In patients with advanced chronic liver disease, acute gastrointestinal bleeding can be classified as acute variceal bleeding or nonvariceal bleeding. We aim to compare clinical outcomes between variceal and nonvariceal bleeding in patients with advanced chronic liver disease and to identify predictors of liver-related death following variceal bleeding. METHODS: Retrospective, observational, and unicenter study. Patients with advanced chronic liver disease presenting with acute gastrointestinal bleeding between 2016 and 2022 were divided into variceal and nonvariceal bleeding groups. Complications, rebleeding, further decompensation, and liver-related death were compared. RESULTS: In total, 154 patients were included. Nonvariceal bleeding group (n = 57) was older (P < 0.001), with higher model for end-stage liver disease-sodium (MELD-Na) (P = 0.016) and ascites at admission (P = 0.033). In-hospital mortality (P = 0.101), complications (P = 0.362), rebleeding (P = 0.102), further decompensation (P = 0.112), and liver-related death in the follow-up (P = 0.112) were similar between groups. In the variceal bleeding group, MELD-Na predicted liver-related death within 30 (P < 0.001) and 90 days (P < 0.001). Variceal bleeding, whether as a first or further decompensation event, was associated with similar risks of 30-day readmission and liver-related death. CONCLUSION: There were no significant differences in outcomes between groups. In the variceal bleeding group, MELD-Na was an independent predictor of liver-related death within 30 and 90 days.