Acute Variceal Bleeding: Does Octreotide Improve Outcomes in Patients with Different Functional Hepatic Reserve?

ABSTRACT

BACKGROUND: Current guidelines do not differentiate in the utilization of vasoactive drugs in patients with cirrhosis and acute variceal bleeding (AVB) depending on liver disease severity. MATERIAL AND METHODS: In this retrospective study, clinical outcomes in 100 patients receiving octreotide plus endoscopic therapy (ET) and 216 patients with ET alone were compared in terms of failure to control bleeding, in-hospital mortality, and transfusion requirements stratifying the results according to liver disease severity by Child-Pugh (CP) score and MELD. RESULTS: In patients with CP-A or those with MELD < 10 octreotide was not associated with a better outcome compared to ET alone in terms of hospital mortality (CP-A 0.0 vs. 0.0%; MELD < 10 0.0 vs. 2.9%, p = 1.00), failure to control bleeding (CP-A 8.7 vs. 3.7%, p = 0.58; MELD < 10 5.3 vs. 4.3%, p = 1.00) and need for transfusion (CP-A 39.1 vs. 61.1%, p = 0.09; MELD < 10 63.2 vs. 62.9%, p = 1.00). Those with severe liver dysfunction in the octreotide group showed better outcomes compared to the non-octreotide group in terms of hospital mortality (CP-B/C 3.9 vs. 13.0%, p = 0.04; MELD ≥ 10 3.9 vs. 13.3%, p = 0.03) and need for transfusion (CP-B/C 58.4 vs. 71.6%, p = 0.05; MELD ≥ 10 50.6 vs. 72.7%, p < 0.01). In multivariate analysis, octreotide was independently associated with in-hospital mortality (p = 0.028) and need for transfusion (p = 0.008) only in patients with severe liver dysfunction (CP-B/C or MELD ≥ 10). CONCLUSION: Patients with cirrhosis and AVB categorized as CP-A or MELD < 10 had similar clinical outcomes during hospitalization whether or not they received octreotide.