- Design
- International multicentre cohort
- Population
- 345 children after a first variceal haemorrhage at 44 centres
- Primary outcome
- Overall survival and survival with native liver; 6-week mortality
- Effect
- 6-week mortality 4.1% (1.4% if not admitted); higher at low-volume centres (p=0.010)
An international study across 44 centres analysed 345 children after a first variceal haemorrhage, and grouped centres by volume and complexity of portal hypertension care.
Overall six-week mortality was 4.1%, and 1.4% in children not admitted, far lower than in adults. Survival was high in portal vein thrombosis and other non-cirrhotic causes, and lower in biliary atresia and cirrhosis. Decompensation at the time of bleeding, poor bile flow after biliary atresia surgery, sclerotherapy, and no endoscopic treatment were linked to worse survival with the native liver. Low-volume centres had higher six-week mortality than high-volume centres.
The findings inform the debate on primary prophylaxis in children: risk depends heavily on the underlying diagnosis, and the centre matters. Children with cirrhotic disease or decompensation after a first bleed are the group to refer early to experienced units.
- Six-week mortality after a first variceal bleed in children was about 4%, much lower than in adults.
- Risk is highest with cirrhosis, biliary atresia with poor bile flow, and decompensation.
- Sclerotherapy was linked to worse outcomes in this cohort, though the children who received it may have differed.
- Refer children with cirrhotic portal hypertension to high-volume centres early.
Why it matters
Outcomes varied by centre, suggesting experience changes survival in a rare emergency.
Don't overread it
Observational; the sclerotherapy association may reflect which children received it rather than the treatment itself.
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