Evaluating The Prognostic Value of Variceal Bleeding Using Child-Pugh Stratification in The Outcome of Chronic Liver Disease: Rebleeding and Mortality

Original Article

Abstract

Background: Variceal bleeding is a life-threatening complication of chronic liver disease (CLD) that has a high frequency of recurrent bleeding and mortality. Child-Pugh classification is a widely used scoring system for evaluating hepatic dysfunction and may be useful for predicting outcomes after acute variceal hemorrhage.

Objective: To evaluate the prognostic value of Child-Pugh classification in predicting recurrent variceal bleeding and mortality among patients with chronic liver disease presenting with acute variceal bleeding.

Methodology: This cross-sectional study was conducted in the Department of General Medicine, Sandeman Provincial Hospital, Bolan Medical College, Quetta, Balochistan, Pakistan, from March to August 2025. A total of 126 consecutive patients with chronic liver disease presenting with acute variceal bleeding were included using consecutive non-probability sampling. Patients were classified into Child-Pugh Classes A, B, or C based on clinical and laboratory findings at admission. Standard medical and endoscopic management was provided to all patients. Data were analyzed using SPSS version 27.0, and a p-value <0.05 was considered statistically significant.

Results: Among 126 patients, 32 (25.4%) were classified as Child-Pugh Class A, 51 (40.5%) as Class B, and 43 (34.1%) as Class C. Rebleeding within six weeks occurred in 2 (6.3%), 14 (27.5%), and 24 (55.8%) patients in Child-Pugh Classes A, B, and C, respectively (p < 0.001). In-hospital mortality increased from 1 (3.1%) in Class A to 6 (11.8%) in Class B and 16 (37.2%) in Class C (p < 0.001). Multivariable logistic regression identified Child-Pugh Class C as an independent predictor of recurrent bleeding (adjusted OR 6.58; 95% CI 2.41–17.94; p < 0.001) and mortality (adjusted OR 8.74; 95% CI 2.35–32.49; p = 0.001).

Conclusion: Child-Pugh stratification is a reliable prognostic tool for identifying patients at increased risk of recurrent variceal bleeding and mortality. It is potentially beneficial for early risk stratification, treatment choices, and patient outcomes when used routinely.