Improved clinical outcomes of patients with cirrhosis and acute variceal bleeding over the last 2 decades

Background and Aims: Acute variceal bleeding (AVB), a severe adverse event of portal hypertension, may cause death in patients with cirrhosis. We investigated whether outcomes after AVB have improved over time. Methods: Data from 406 patients with cirrhosis with AVB (2000-2022) from 2 Viennese centers were analyzed for recurrent bleeding, 6-week mortality, and 1-year transplant-free survival. Results: Recurrent bleeding rates within 6 weeks decreased from 19.4% to 11.8% (hazard ratio [HR], 0.59; 95% CI, 0.35-0.97; P = .049) and bleeding-related mortality decreased from 23.6% to 18.3% (HR, 0.68; 95% CI, 0.44-1.06; P = .099). One-year transplant-free survival after AVB improved from 63.8% to 73.7% (HR, 0.68; 95% CI, 0.47-0.97; P = .041). Higher Child-Pugh scores were associated with increased risk for bleeding (adjusted odds ratio [aOR], 1.68) and mortality (aOR, 1.69; both P < .001). Nonselective beta-blockers reduced 1-year mortality risk (aOR, 0.48; P = .038). Conclusions: Recurrent bleeding and mortality rates after AVB improved over the last 2 decades but remain substantial, highlighting the need for continued efforts to optimize outcomes for patients with cirrhosis.