C-Reactive Protein can Predict Patients with Cirrhosis at a High Risk of Early Mortality after Acute Esophageal Variceal Bleeding

Prediction of mortality after variceal bleeding

Abstract

Objective The aim of this study was to identify patients with a high risk of early mortality after acute esophageal variceal bleeding by measuring the C-reactive protein (CRP) level.

Methods We retrospectively evaluated 154 consecutive cirrhotic patients admitted with esophageal variceal bleeding. Differences between categorical variables were assessed by the chi-square test. Continuous variables were compared using the Mann-Whitney U-test. Multivariate logistic regression analyses consisting of clinical laboratory parameters were performed to identify risk factors associated with the six-week mortality. The discriminative ability and the best cut-off value were assessed by a receiving-operator characteristic (ROC) curve analysis.

Results Child-Pugh C patients showed a significantly higher 6-week mortality than Child-Pugh A or B patients (38% vs. 6%, p<0.0001). The 6-week mortality in Child-Pugh C patients was associated with the age (p<0.0001), etiology of cirrhosis (p=0.003), hepatocellular carcinoma (p=0.0003), portal vein thrombosis (p=0.005), baseline creatinine (p=0.0001), albumin (p=0.001), white blood cell count (p=0.038), baseline CRP (p=0.0004; area under the ROC [AUROC]=0.765; optimum cut-off value at 1.30 mg/dL) and bacterial infection (p=0.019). We determined that CRP ≥1.30 mg/dl was an independent predictor for 6-week mortality in Child-Pugh C patients (odds ratio [OR]=8.789; 95% confidence interval [CI]: 2.080-47.496; p=0.003), along with a creatinine level of 0.71 mg/dL (OR=17.628; 95% CI: 2.349-384.426; p=0.004) (73% mortality if CRP ≥1.30 mg/dL vs. 19% if CRp<1.30 mg/dL, p<0.0001).

Conclusion In Child-Pugh C patients with esophageal variceal bleeding, a baseline CRP ≥1.30 mg/dl can help identify patients with an increased risk of mortality.