Clinical Outcomes and Predictors of Mortality in Variceal Upper Gastrointestinal Bleeding: A Retrospective Study From a Tertiary Care Hospital

Background Variceal upper gastrointestinal bleeding (UGIB) is a life-threatening complication of portal hypertension and cirrhosis, associated with high morbidity and mortality. The objective of this study was to evaluate the clinical outcomes and identify independent predictors of six-week mortality in patients presenting with variceal UGIB at a tertiary care center, while providing locally representative data from a large cohort in a low- to middle-income country to strengthen region-specific evidence. Methodology This retrospective observational study was conducted at Shalamar Hospital, Lahore, Pakistan, from June 2020 to June 2025. It included 355 patients admitted with endoscopically confirmed variceal UGIB. Data regarding demographics, clinical presentation, laboratory parameters, endoscopic findings, treatment modalities, and outcomes were collected from hospital records. Results The mean age of patients was 52.3 ± 12.8 years, with 59.7% male patients. Most patients (83.9%) had known cirrhosis, and hematemesis was the most frequent presentation (69.0%). Endoscopic variceal ligation was the commonest intervention (76.3%). Initial hemostasis was achieved in 86.5% of patients. Rebleeding occurred in 20.8%, while the mean hospital stay was 6.9 ± 3.4 days. The overall six-week mortality was 21.1%. Independent predictors of mortality included rebleeding (AOR: 3.91; 95% CI: 2.10-7.30; p < 0.001), Child-Pugh class C (AOR: 2.84; 95% CI: 1.52-5.30; p = 0.001), and hemodynamic instability at admission (AOR: 2.76; 95% CI: 1.44-5.28; p = 0.002). Conclusion Variceal UGIB continues to pose a major clinical challenge, with significant mortality despite effective endoscopic and pharmacological interventions. Advanced liver dysfunction, rebleeding, and shock at presentation strongly predict poor outcomes.