Acute variceal haemorrhage in the United Kingdom: Patient characteristics, management and outcomes in a nationwide audit

Abstract Background Despite advances in treatment, acute variceal haemorrhage remains life-threatening. Aim To describe contemporary characteristics, management and outcomes of patients with cirrhosis and acute variceal haemorrhage and risk factors for rebleeding and mortality. Methods Multi-centre clinical audit conducted in 212 UK hospitals. Results In 526 cases of acute variceal haemorrhage, 66% underwent endoscopy within 24 h with 64% ( n  = 339) receiving endoscopic therapy. Prior to endoscopy, 57% ( n  = 299) received proton pump inhibitors, 44% ( n  = 232) vasopressors and 27% ( n  = 144) antibiotics. 73% ( n  = 386) received red cell transfusion, 35% ( n  = 184) fresh frozen plasma and 14% ( n  = 76) platelets, with widely varying transfusion thresholds. 26% ( n  = 135) experienced further bleeding and 15% ( n  = 80) died by day 30. The Model for End Stage Liver Disease score was the best predictor of mortality (area under the receiver operating curve = 0.74, P P  = 0.01, up to day 30) and mortality (odds ratio 3.06, 95% CI 1.29–7.26, P  = 0.01). Conclusions Although mortality has improved following acute variceal haemorrhage, rebleeding rates remain appreciably high. There are notable deficiencies in the use of vasopressors and endoscopic therapy. More work is needed to understand the optimum transfusion strategies. Better risk stratification tools are required to identify patients needing more intensive support.