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. 2014 Dec 21;20(47):17941-8.
doi: 10.3748/wjg.v20.i47.17941.

Risk factors for early rebleeding and mortality in acute variceal hemorrhage

Jing-Run Zhao  1 , Guang-Chuan Wang  1 , Jin-Hua Hu  1 , Chun-Qing Zhang  1
Affiliations

Risk factors for early rebleeding and mortality in acute variceal hemorrhage

Jing-Run Zhao et al. World J Gastroenterol. .

Abstract

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 mmHg 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 mmHg 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.

Keywords: Acute variceal hemorrhage; Hepatic vein pressure gradient; Percutaneous transhepatic variceal embolization.

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Figures

Figure 1
Figure 1
Kaplan-Meier plots showing the cumulative incidence of rebleeding in 6 wk stratified according to (A) risk stigmata of variceal bleeding, (B) obliteration range of percutaneous transhepatic variceal embolization, and (C) hepatic vein pressure gradient. The curves are compared using a log-rank test. PTVE: Percutaneous transhepatic variceal embolization; HVPG: Hepatic vein pressure gradient.
Figure 2
Figure 2
Kaplan-Meier plots showing the cumulative incidence of death in 6 wk stratified according to model for end-stage liver disease (A) and hepatic vein pressure gradient (B). The curves are compared using a log-rank test. MELD: Model for end-stage liver disease; HVPG: Hepatic vein pressure gradient.
See this image and copyright information in PMC

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