1 Springer Indian J Gastroenterol 2009(May–June):28(3):93–95 Abstract Variceal bleed is a severe complication of portal hypertension. We studied the predictors of failure to control variceal bleed and re-bleed in patients with cirrhosis. We reviewed the case records of 382 consecutive patients admitted with variceal bleed from January 2001 to December 2005. Diagnosis of cirrhosis was made on clinical, laboratory, and radiological parameters. Acute variceal bleeding, failure to control bleed, and re-bleeding were defined according to Baveno III con- sensus report. Failure to control bleed was observed in 39 (10.2%) patients while in hospital re-bleed occurred in 49 (12.8%) patients. Thirty-four patients died. Diabetes was present in 148 (39%) patients. On multivariate logistic regression analysis, predictors of failure to control bleed were presence of diabetes mellitus and active bleeding at the time of endoscopy; predictors of in-hospital re-bleed were diabetes mellitus and serum bilirubin >3 mg/dL. Diabetes mellitus, active bleeding at endoscopy and bilirubin >3 mg/dL are bad prognostic factors for initial control of variceal bleed, and recurrent bleed in patients with cirrhosis. Keywords Diabetes mellitus · Gastric varix · Gastro-intes- tinal hemorrhage · Portal hypertension Introduction Gastro-esophageal varices are present in 40–60% of patients with cirrhosis; bleeding occurs in 25–35% of patients and account for 80–90% of bleeding episodes in these patients. 1 Hepatic venous pressure gradient (HVPG) >20 mmHg is associated with early re-bleed and failure to control bleeding (83%) with high mortality (64%). 2 In the last two decades variceal re-bleeding has decreased with the use of pharma- cological, endoscopic, and radiological interventions. 3 Various factors have been proposed as predictors of outcome of variceal bleed such as age of the patient, gender, stage of cirrhosis, etiology of the disease, associated con- ditions like renal failure, hepatocellular carcinoma, and diabetes mellitus (DM). In most of the cases, DM seems to follow cirrhosis and is called hepatogenous diabetes. Early cirrhosis with DM is characterized by marked postprandial hyperglycemia and insulin resistance. 4 The higher mortality rate in patients with diabetes is not only due to the compli- cations of DM but also to an increased risk of hepatocellular failure in long-term follow up. 5 Hyperglycemia induces splanchnic hyperemia, increases portal pressure and may increase the risk of variceal bleeding. 6,7 The aim of our study was to determine the factors predicting failure to control variceal bleed and re-bleed in cirrhotic patients. Methods Case records of consecutive patients admitted under Gastroenterology service at our hospital with acute portal hypertension-related bleeds from January 2001 to December 2005 were analyzed. Complete blood count and liver function tests were done in all patients. Cirrhosis and portal hypertension were diagnosed on the basis of ultrasound and/or CT scan of the abdomen, and liver biopsy, when available. Clinical and biochemical variables including age, gender, Child–Pugh class, site of varices, and etiology of cirrhosis were recorded. Source of upper gastrointestinal bleed was confirmed by esophago-gastroduodenoscopy (EGD). Esophageal varices were graded I–IV. 8 Gastric varices were classified as described by Sarin and Kumar. 9 The source of bleeding was identified as variceal if there was active bleeding from a varix or there were signs of recent bleeding from a varix, or there was a single varix without any other potential source of bleeding. Indian J Gastroenterol 2009(May–June):28(3):93–95 SHORT REPORT Factors determining the clinical outcome of acute variceal bleed in cirrhotic patients Shahid Majid · Zahid Azam · Hasnain Ali Shah · Mohammad Salih · Saeed Hamid · Shahab Abid · Wasim Jafri S. Majid · Z. Azam · H. A. Shah · M. Salih · S. Hamid · S. Abid · W. Jafri Section of Gastroenterology, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan H. A. Shah () e-mail: hasnain.alishah@aku.edu Received: 29 July 2008 / Revised: 22 December 2008 / Accepted: 10 February 2009 © Indian Society of Gastroenterology 2009