Retrospective Cohort Study
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World J Gastroenterol. Dec 21, 2014; 20(47): 17941-17948
Published online Dec 21, 2014. doi: 10.3748/wjg.v20.i47.17941
Risk factors for early rebleeding and mortality in acute variceal hemorrhage
Jing-Run Zhao, Guang-Chuan Wang, Jin-Hua Hu, Chun-Qing Zhang
Jing-Run Zhao, Guang-Chuan Wang, Jin-Hua Hu, Chun-Qing Zhang, Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
Jing-Run Zhao, Department of Gastroenterology, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
Author contributions: Zhang CQ designed the research; Zhao JR, Hu JH and Wang GC collected the data and performed the research; Zhao JR and Hu JH analyzed the data and were responsible for the statistical work; Zhao JR drafted the article; Zhang CQ critically revised the manuscript for important intellectual content.
Correspondence to: Chun-Qing Zhang, MD, Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Weiqi Road, Jinan 250021, Shandong Province, China. zhchqing@medmail.com.cn
Telephone: +86-531-66953227 Fax: +86-531-87906348
Received: May 13, 2014
Revised: July 16, 2014
Accepted: August 13, 2014
Published online: December 21, 2014
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, Percutaneous transhepatic variceal embolization, Hepatic vein pressure gradient

Core tip: Acute variceal hemorrhage (AVH) is a medical emergency with a 20% mortality rate at 6 wk. Percutaneous transhepatic variceal embolization (PTVE) is a rescue therapy for endoscopic variceal ligation failure. Here we present a retrospective study to determine the risk factors for 6-wk rebleeding and mortality in AVH patients who have undergone PTVE. Patients with a model for end-stage liver disease score ≥ 18 and an HVPG ≥ 20 mmHg are at increased risk of death within 6 wk of an acute variceal bleeding episode. A transjugular intrahepatic portosystemic shunt or liver transplantation should be considered for this high-risk group.