3 million inpatients in the database. The median age was 63 years and 68.8% were male. The overall in-hospital mortality was 16.8% (1676 cases). In univariate analysis, Child-Pugh class was the strongest predictor; area under check details the ROC curve of Child-Pugh score for

predicting in-hospital mortality was 0.802. In multivariate analysis, increased in-hospital mortality was significantly associated with male gender (vs. female: odds ratio [〇R] = 1.19, P = 0.01), older age, ChildPugh class (B vs. A: 〇R=2.80, P <0.001; C vs. A: 〇R=20.1, P <0.001), and higher Charlson Comorbidity index (6 or more vs.5 or less; 〇R=1.29, P <0.001). Conclusions In spite of recent advance in the treatment of variceal hemorrhage, the mortality was as high as 16%. Poor liver function was the most important predictor, which suggested that liver failure after the treatment of gastroesophageal varices would be the cause of death. Disclosure: Ryosuke Tateishi - Grant/Research Support: Eisai Co. Ltd. Kazuhiko Koike - Speaking and Teaching: Bristol-Myers Squibb The following people have nothing to disclose: Masaya Sato, Hideo Yasunaga, Haruhiko Yoshida Introduction Current guidelines for

secondary prophylaxis of variceal bleeding recommend a combination of pharmacologic therapy (beta blockers +/- nitrates) and endoscopic band ligation (EBL). However, the use of hepatic venous pressure gradient selleck inhibitor (HVPG) monitoring identifies a subset of patients with a low risk of bleeding on pharmacologic therapy alone. Patients with HVPG < 12mmHg or those with a reduction of HVPG ≥ 20% from baseline have a low incidence of re-bleeding. A treatment algorithm in which responders are treated with pharmacotherapy alone could be rational and cost effective compared to standard therapy. Methods A

Monte Carlo simulation of a Markov state model was performed selleck compound to compare two strategies (analyses performed with R, Vienna, Austria). Strategy 1: Patients undergo HVPG monitoring with pharmacologic therapy. Patients with an appropriate HVPG response at one week following initiation of beta blocker/isosorbide mononitrate are continued on pharmacologic therapy only. Patients who do not respond to pharmacologic therapy are continued on pharmacologic therapy with the addition of endoscopic band ligation. Strategy 2: Patients do not undergo monitoring of HVPG and are treated with a combination of a beta blocker/isosorbide mononitrate with EBL. Costs of procedures (HVPG and EBL), medications, and hospitalizations were estimated using AMA CPT codes and national average billing costs, generic pharmaceutical retail prices, and estimates from prior literature. The rates of response to pharmaceutical therapy, recurrent GI bleeding, and mortality were estimated from a review of relevant literature obtained form the Medline database. The main outcome of interest was cost per recurrent variceal hemorrhage prevented at one year.