Independent factors associated with early outcome in Chinese cirrhotic patients after cessation of initial esophageal variceal hemorrhage

Abstract

BACKGROUND, PURPOSE, AND METHOD: Cirrhotic patients with acute esophageal variceal (EV) hemorrhage are characterized by high mortality. This study was conducted to investigate the independent indicators of mortality in Chinese cirrhotic patients within 6 weeks after cessation of initial EV bleeding. Ninety-seven consecutive cirrhotic patients with EV bleeding but without evidence of infection who were admitted to our hospital between December 2006 and February 2009 were retrospectively analyzed. Ten patients who died and 87 patients who survived were enrolled in the mortality and survival groups, respectively. The characteristics and laboratory data at admission of patients in the 2 groups were compared. Time of death in the mortality group, rebleeding and infection in both the mortality and survival groups were also evaluated.

Results: The incidence of mortality after cessation of initial EV bleeding was 10.3% (10/97). Incidences of infection and rebleeding were significantly higher in the mortality group than in the survival group (60% vs. 21%, 70% vs. 8%). Other parameters such as age, sex, etiology of liver cirrhosis, severity of liver disease (ascites, spleen diameter, platelet count, hepatocellular carcinoma, portal vein thrombosis), severity of EV bleeding (hemoglobin, blood pressure, requirements of blood transfusion), and differential vasoactive medications had no significant influence on incidence of mortality. All deaths were caused by rebleeding or sepsis, and all rebleeding occurred before infection. Most (67%) patients with rebleeding had postbanding ulcer bleeding. Generally, mortality, rebleeding, and infection occurred within 2 weeks after cessation of initial EV bleeding.

Conclusions: This study provides evidence that the incidence of early mortality after cessation of initial EV bleeding is significantly associated with bacterial infection and rebleeding. Rebleeding can increase the possibility of infection. Therefore, prevention of infection and rebleeding plays a major role in improving the early outcome in Chinese cirrhotic patients with EV bleeding.