Predictive factors for rebleeding and death in alcoholic cirrhotic patients with acute variceal bleeding: A multivariate analysis

Department of Surgery J45OMB, Groote Schuur Hospital, Anzio Road, Observatory 7925, Cape Town, South Africa.
World Journal of Surgery (Impact Factor: 2.64). 09/2009; 33(10):2127-35. DOI: 10.1007/s00268-009-0172-6
Source: PubMed


Bleeding from esophageal varices is a leading cause of death in alcoholic cirrhotic patients. The aim of the present single-center study was to identify risk factors predictive of variceal rebleeding and death within 6 weeks of initial treatment.
Univariate and multivariate analyses were performed on 310 prospectively documented alcoholic cirrhotic patients with acute variceal hemorrhage (AVH) who underwent 786 endoscopic variceal injection treatments between January 1984 and December 2006. All injections were administered during the first 6 weeks after the patients were treated for their first variceal bleed.
Seventy-five (24.2%) patients experienced a rebleed, 38 within 5 days of the initial treatment and 37 within 6 weeks of their initial treatment. Of the 15 variables studied and included in a multivariate analysis using a logistic regression model, a bilirubin level >51 mmol/l and transfusion of >6 units of blood during the initial hospital admission were predictors of variceal rebleeding within the first 6 weeks. Seventy-seven (24.8%) patients died, 29 (9.3%) within 5 days and 48 (15.4%) between 6 and 42 days after the initial treatment. Stepwise multivariate logistic regression analysis showed that six variables were predictors of death within the first 6 weeks: encephalopathy, ascites, bilirubin level >51 mmol/l, international normalized ratio (INR) >2.3, albumin <25 g/l, and the need for balloon tube tamponade.
Survival was influenced by the severity of liver failure, with most deaths occurring in Child-Pugh grade C patients. Patients with AVH and encephalopathy, ascites, bilirubin levels >51 mmol/l, INR >2.3, albumin <25 g/l and who require balloon tube tamponade are at increased risk of dying within the first 6 weeks. Bilirubin levels >51 mmol/l and transfusion of >6 units of blood were predictors of variceal rebleeding.

18 Reads

  • DMW - Deutsche Medizinische Wochenschrift 03/2010; 135(09):399-408. DOI:10.1055/s-0030-1249177 · 0.54 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: RésuméL’hémorragie digestive haute demeure une cause fréquente d’hospitalisation, de morbidité et de mortalité. Les études épidémiologiques sont limitées dans notre pays. ButDéterminer les causes et l’évolution des patients ayant une hémorragie digestive haute, colligés au CHU deMonastir. Matériels et méthodesLes dossiers de 874 patients qui ont subi une endoscopie digestive haute pour hémorragie digestive pendant une durée de dix ans (1997–2007) ont été rétrospectivement analysés. RésultatsLes hémorragies digestives hautes ont représenté 5,3 % de l’ensemble des endoscopies digestives hautes. On avait noté une nette prédominance masculine (63,1 %), avec un âge moyen de 54 ± 12 ans. L’origine de saignement a été détectée dans 90 % des cas. La précision diagnostique était plus grande quand l’endoscopie est pratiquée dans les 24 premières heures suivant l’apparition de l’hémorragie, et en présence de l’hématémèse. L’ulcère gastroduodénal est la cause la plus fréquente de l’hémorragie digestive haute (50,5 %), suivi des gastroduodénites hémorragiques (24 %). La prévalence de l’hémorragie digestive par rupture des varices oesogastriques était de 9,49 %. Le traitement endoscopique a été utilisé dans 103 cas (11,7 %). Une intervention chirurgicale a été effectuée chez 51 patients (5,83 %), incluant 9,9 % des patients ayant un ulcère hémorragique. Trente-six patients étaient décédés (4,1 %). ConclusionL’ulcère hémorragique est la cause la plus fréquente d’hémorragie digestive dans notre pays. La mortalité était élevée dans le groupe des patients ayant saigné par rupture des varices oesogastriques. La plupart des cas d’hémorragie digestive haute peuvent être traités par hémostase endoscopique, quand l’endoscopie diagnostique établit la source. BackgroundAcute upper gastrointestinal bleeding (UGIB) continues to be a common cause of hospital admission and morbidity and mortality. Epidemiological studies are still limited in our country. Aim and objectivesThe aim of this study is to determine the causes and outcome of patients with UGIB presenting at the teaching hospital of Monastir. Materials and methodsThe study was carried out at the teaching hospital of Monastir. The records of 874 patients who underwent endoscopy for UGIB over a period of 10 years (1997–2007) were retrospectively analysed. ResultsThe acute UGIB represented 5.3% of all high digestive endoscopy. Male predominance (63.1%) was noted with an average age of 54 ± 12 years. A bleeding site could be detected in 75.6% of the patients. Diagnostic accuracy was greater within the first 24 hours of the bleeding onset and in the presence of hematemesis. Peptic ulcer was the main cause of UGIB (50.5%) followed by erosive mucosal disease (24%). The prevalence of variceal bleeding was 9.49%. Endoscopic treatment was used in 103 cases (11.7%). Operations were performed in 51 cases (9.9%), including 9.9% of ulcers. There were 36 deaths (4.1%). ConclusionPeptic ulcer was the most common cause of gastrointestinal bleeding in our country. Mortalitywas raised in variceal group. Most cases of UGIB can be treated with endoscopic hemostasis, when diagnostic endoscopy establishes the source. Mots clésHémorragie digestive haute-Ulcère gastroduodénal-Gastroduodénite hémorragique-Endoscopie KeywordsAcute upper gastrointestinal bleeding-Peptic ulcer-Erosive mucosal disease
    Acta Endoscopica 06/2010; 40(3):176-182. DOI:10.1007/s10190-010-0049-4 · 0.16 Impact Factor
Show more