Prognostic indicators in acute variceal hemorrhage after treatment by schlerotherapy

Abstract

The purpose of the study was to evaluate prognostic indicators in patients receiving endoscopic injection sclerosis for bleeding esophageal varices. The results below were obtained from a prospective nonrandomized study in which the patients were subdivided into the following groups (subsets): elective sclerotherapy--10, active variceal bleeding at endoscopy--47, active variceal bleeding with spontaneous resolution at the time of endoscopy--21, and gastric variceal bleeding--nine. The data were analyzed as follows: 14 variables possibly affecting 6-wk survival were evaluated by stepwise logistic regression analysis. Variables examined were subset, age, sex, Child's classification, ascites, comorbid conditions, SGOT, bilirubin, protime, albumin, volume of initial bleed, volume of rebleed, rebleed rate, and Blakemore tube use. Survival curves were also compared using the Kaplan-Meier methodology. The following results were obtained. First, the subsets above had significantly different survival curve patterns with the elective endoscopic injection sclerosis group having the best prognosis and the gastric variceal bleeders a significantly poorer survival. Second, stepwise logistic regression analysis revealed the following four significant variable prognostic indicators: comorbid factors, subset, Child's classification, and serum albumin. Although the latter two variables, Child's class (p = 0.03) and albumin (p = 0.1) had an impact on six week survival, this was no longer seen when subset (p = 0.0124) and comorbid factors (p = 0.003) were taken into account. We conclude that comorbid factors and subsets of variceal bleeding in themselves were the only two prognostic indicators showing a statistically significant association with 6-wk and long-term survival. In contrast, the more usual clinical prognostic parameters, i.e., the physical findings and biochemical test of liver function in patients with cirrhosis and acute variceal bleeding, were of lesser prognostic magnitude.