Risk factors for early rebleeding and mortality in acute variceal hemorrhage

AIM:To investigate the risk factors for 6-wk rebleeding and mortality in acute variceal hemorrhage(AVH)patients treated by percutaneous transhepatic variceal embolization(PTVE).METHODS:A retrospective cohort study of AVH patients who had undergone PTVE treatment was conducted between January 2010 an...

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Published in:World journal of gastroenterology : WJG 2014-12, Vol.20 (47), p.17941-17948
Main Authors: Zhao, Jing-Run, Wang, Guang-Chuan, Hu, Jin-Hua, Zhang, Chun-Qing
Format: Article
Language:English
Subjects:
Acute
Acute Disease
Adult
Embolization, Therapeutic - adverse effects
Embolization, Therapeutic - mortality
Esophageal and Gastric Varices - diagnosis
Esophageal and Gastric Varices - mortality
Esophageal and Gastric Varices - physiopathology
Esophageal and Gastric Varices - therapy
Female
Gastrointestinal Hemorrhage - diagnosis
Gastrointestinal Hemorrhage - mortality
Gastrointestinal Hemorrhage - physiopathology
Gastrointestinal Hemorrhage - therapy
hemorrhage
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Percutaneous
Portal Pressure
Portal Vein - physiopathology
Proportional Hazards Models
Recurrence
Retrospective Cohort Study
Retrospective Studies
Risk Factors
Time Factors
transhepati
Treatment Outcome
variceal
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Summary:AIM:To investigate the risk factors for 6-wk rebleeding and mortality in acute variceal hemorrhage(AVH)patients treated by percutaneous transhepatic variceal embolization(PTVE).METHODS:A retrospective cohort study of AVH patients who had undergone PTVE treatment was conducted between January 2010 and December 2012.Demographic information,medical histories,physical examination findings,and laboratory test results were collected.The PTVE procedure was performed as a rescue therapy for patients who failed endoscopic and pharmacologic treatment.Survival analysis was estimated using the Kaplan-Meier method and compared using the log-rank test.The multivariate analysis was performed using the Cox regression test to identify independent risk factors for rebleeding and mortality.RESULTS:One hundred and one patients were included;71 were males and the average age was 51 years.Twenty-one patients rebled within 6 wk.Patients with high-risk stigmata,PTVE with trunk obliteration,and a hepatic vein pressure gradient(HVPG)≥20 mm Hg were at increased risk for rebleeding(OR=5.279,95%CI:2.782-38.454,P=0.003;OR=4.309,95%CI:=2.144-11.793,P<0.001;and OR=1.534,95%CI:1.062-2.216,P=0.022,respectively).Thirteen patients died within 6 wk.A model for end-stage liver disease(MELD)score≥18 and an HVPG≥20 mm Hg were associated with 6-wk mortality(OR=2.162,95%CI:1.145-4.084,P=0.017 and OR=1.423,95%CI:1.222-1.657,P<0.001,respectively).CONCLUSION:MELD score and HVPG in combination allow for early identification of patients with AVH who are at substantially increased risk of death over the short term.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v20.i47.17941