Prognosis depends on the aetiology of the portal hypertension which led to the development of varices, as well as the patient’s liver function. Decompensated cirrhosis is characterised by complications such as ascites, variceal bleeding, encephalopathy, and/or jaundice.[36]Gow PJ, Chapman RW. Modern management of oesophageal varices. Postgrad Med J. 2001 Feb;77(904):75-81.
https://pmj.bmj.com/content/77/904/75.long
http://www.ncbi.nlm.nih.gov/pubmed/11161071?tool=bestpractice.com
[37]British Society of Gastroenterology; British Association for the Study of the Liver. Decompensated cirrhosis: an update of the BSG/BASL admission care bundle. Apr 2025 [internet publication].
https://www.bsg.org.uk/clinical-resource/new-decompensated-cirrhosis-admission-care-bundle
Nearly 30% of patients with oesophageal varices bleed within the first year after diagnosis.[82]Solanki S, Haq KF, Chakinala RC, et al. Inpatient burden of esophageal varices in the United States: analysis of trends in demographics, cost of care, and outcomes. Ann Transl Med. 2019 Sep;7(18):480.
https://atm.amegroups.org/article/view/28320/25804
http://www.ncbi.nlm.nih.gov/pubmed/31700916?tool=bestpractice.com
Patients admitted with oesophageal variceal bleeding have a significantly higher risk of in-hospital mortality compared with those admitted with non-bleeding varices.[82]Solanki S, Haq KF, Chakinala RC, et al. Inpatient burden of esophageal varices in the United States: analysis of trends in demographics, cost of care, and outcomes. Ann Transl Med. 2019 Sep;7(18):480.
https://atm.amegroups.org/article/view/28320/25804
http://www.ncbi.nlm.nih.gov/pubmed/31700916?tool=bestpractice.com
Acute variceal haemorrhage requires timely and effective management to reduce short-term mortality, which is often due to associated complications such as aspiration, infection, or acute kidney injury.[37]British Society of Gastroenterology; British Association for the Study of the Liver. Decompensated cirrhosis: an update of the BSG/BASL admission care bundle. Apr 2025 [internet publication].
https://www.bsg.org.uk/clinical-resource/new-decompensated-cirrhosis-admission-care-bundle
Even with therapeutic advancements, 6-week mortality remains between 10% and 15%.[6]Kaplan DE, Ripoll C, Thiele M, et al. AASLD practice guidance on risk stratification and management of portal hypertension and varices in cirrhosis. Hepatology. 2024 May 1;79(5):1180-211.
https://journals.lww.com/hep/fulltext/2024/05000/aasld_practice_guidance_on_risk_stratification_and.22.aspx
http://www.ncbi.nlm.nih.gov/pubmed/37870298?tool=bestpractice.com
The factors most consistently associated with increased 6-week mortality are Child-Pugh class C, a higher Model for End-Stage Liver Disease (MELD) score, and failure to achieve primary haemostasis.[29]de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII - Renewing consensus in portal hypertension. J Hepatol. 2022 Apr;76(4):959-74.
https://www.journal-of-hepatology.eu/article/S0168-8278(21)02299-6/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/35120736?tool=bestpractice.com