الفهرس 
CirrhosisOnly 14 pages are availabe for public view
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Abstract
portal hypertension leads to the development of portosystemic collateral venous vessels. Every year 5% to 10% of patients with cirrhosis will develop esophageal varices (Sostres and Lanas,2011). Esophageal varices develop in patients with cirrhosis at an annual rate of 5–10%, but the varices are large enough to pose a risk of bleeding in only 1–2% of cases (Vijay and Patrick ,2016). Upper gastrointestinal bleeding (UGIB) is the loss of blood through the gastrointestinal tract whose origin proximal to the Treitz angle (Laine L, et al., 2016). Variceal hemorrhage is a complication of cirrhosis that denotes decompensation and that still has a high mortality rate (Fortune B, et al ., 2017). The management of variceal bleeding has improved over the last decades and is well codified including vasoactive drugs, antibiotics prophylaxis, and endoscopic therapy. However, the 6-week mortality after an episode of gastrointestinal bleeding still ranges from 10 to 20% and is higher in patients with severe cirrhosis (de Franchis R,et al.,2015) . The causes of mortality are uncontrolled bleeding, infection, and renal failure. Factors associated with poor prognosis are a high-MELD score, renal failure, elevated hepatic venous pressure gradient (HVPG) > 20 mmHg, and active bleeding at endoscopy (Vuachet D, et al., 2015). Summary & Conclusion 110 The aim of our study was to evaluate the outcome of patients who presented with acute variceal bleeding and to determine which was the suitable prognostic model for the prediction of this outcome. This study was aprospective study carried out on about 310 cirrhotic patients with bleeding varices ,210 excluded and 100 included .After first attack of bleeding 85 patients lived and 15 patients died, after 6 months 64 patients were survivors and 21 were non survivors. Total death after 6months were 36 patients. Predictors of death after first attack of bleeding: Hemodynamic instability has been reported to be a significant risk factor for rebleeding and mortality. Increase serum creatinine , INR , decrease serum albumin and thrombocytopenia, are risk factors for mortality after first 6 weeks of bleeding. Increased MELD, AIMS56 , APACHE II and ROCKall scores were risk factors for mortality after first 6 weeks of bleeding. Predictors of rebleading within 6 weeks: Leucocytosis, increase Alt, Ast , and bilirubin associated with increased risk of rebleading. Increase INR, Activity and Serum creatinine and decrease albumin associated with increased risk of rebleading. Increase Child, MELD, AIMS56 , and Sofa scores were risk factors for early rebleading. Summary & Conclusion 111 Predictors of survival after 6 months: Leucocytosis, increase Alt, Ast , bilirubin associated with decrease survival after 6 months of bleeding. Increase INR, Activity and Serum creatinine and Urea, decrease albumin associated with decrease survival after 6 months of bleeding. Increased Child score was risk factor for mortality after 6 months of bleeding. AIMS56 score has 92.94 sensetivity, 46.67 specificity and 69.9% accuracy.ROCKall score has 80.00 sensetivity, 73.33 specificity and accuracy 74.4%. ROCKall score was the most suitable score for predicting mortality after first attack of bleeding.