Prognostic factors associated with mortality in patients with gastric fundal variceal bleeding

doi:10.3748/wjg.v23.i3.496

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Jan 21, 2017; 23(3): 496-504
Published online Jan 21, 2017. doi: 10.3748/wjg.v23.i3.496

Table 1 Baseline demographics and characteristics of patients with gastric fundal variceal bleeding

Parameters	n (%)
Sex ratio (F/M)	13/29
Mean age (yr)	64.9 ± 11.6
Mean follow-up period (d)	631 ± 109.6
History
Smoking (presence/absence)	21/21 (50)
Alcohol (presence/absence)	20/22 (47.6)
Disease conditions
Child-Pugh classification (A/B/C)	4/20/18
Hepatocellular carcinoma (presence/absence)	14/28 (33.3)
Hepatic encephalopathy (presence/absence)	6/36 (14.3)
Form of gastric fundal varices (F1-F2/F3)	4/38
Concurrent esophageal varices (presence/absence)	30/12 (71.4)
Previous treatment of gastric varices (presence/absence)	1/41 (2.4)
Etiology of liver cirrhosis
Hepatitis B	5 (11.9)
Hepatitis C	18 (42.9)
Alcoholic	12 (28.6)
Others	7 (16.6)
Treatment of gastric fundal varices
Success of initial treatment (total success/total failure)	39/3 (92.9)
Endoscopic treatment (EIS) (success/failure)	30/1 (96.7)
Nonendoscopic treatment (success/failure)	8/1 (11.1)
Not applicable	1/1 (50)
Antibiotics (presence/absence)	23/19 (54.8)
Blood transfusion (presence/absence)	38/4 (90.5)
Rebleeding after initial treatment (presence/absence)	10/32 (23.8)
Medications administered before admission
NSAIDs (presence/absence)	5/37 (11.9)
Anticoagulants (presence/absence)	1/41 (2.4)
Proton pump inhibitors (presence/absence)	14/28 (33.3)
Blood test results
Hemoglobin (g/dL)	8.7 ± 1.8
Albumin (g/dL)	2.54 ± 0.44
Bilirubin (mg/dL)	1.98 ± 1.44

Results are presented as mean ± SEM, if applicable. EIS: Endoscopic injection sclerotherapy; NSAIDs: Non-steroidal anti-inflammatory drugs.

Table 2 Factors associated with 90-d mortality related to gastric fundal variceal bleeding

Parameters	Univariate analysis				Multivariate analysis
Parameters	β	P value	R	HR (95%CI)	β	P value	R	HR (95%CI)
Sex (F/M)	0.2393	0.7354	0	1.27 (0.32-5.09)
Age (yr)	0.0291	0.3215	0	1.03 (0.97-1.09)
History
Smoking	0.5698	0.4208	0	1.77 (0.44-7.08)
Alcohol	0.1163	0.8624	0	0.89 (0.24-3.32)
Disease conditions
Child-Pugh classification (C/B/A)	0.7513	0.1991	0	2.12 (0.67-6.67)
Hepatocellular carcinoma	1.6422	0.0209¹	0.23	5.17 (1.28-20.8)	2.3041	0.0092¹	0.28	10.01 (1.77-56.74)
Hepatic encephalopathy	0.8163	0.3115	0	2.26 (0.47-10.99)
Form of GFV (F2 or F3/F1)	−0.263	0.8046	0	0.77 (0.10-6.16)
Concurrent esophageal varices	−0.233	0.7422	0	0.79 (0.20-3.17)
Etiology of liver cirrhosis (non-viral/viral)	−1.215	0.1302	−0.07	0.30 (0.06-1.43)
Treatment of GFV
Success of initial treatment	−2.176	0.0081¹	−0.28	0.11 (0.02-0.57)
Initial treatment (non-EIS/EIS/none)	0.0253	0.9726	0	1.03 (0.24-4.36)
Antibiotics	−1.637	0.0413¹	−0.18	0.19 (0.04-0.94)	−2.5412	0.0086¹	−0.28	0.08 (0.01-0.52)
Blood transfusion	3.1861	0.4892	0	1.96 (0.32-14.68)
Rebleeding after initial treatment	1.5956	0.0177¹	0.24	4.94 (1.32-18.42)
Medications before admission
NSAIDs	0.5802	0.4697	0	1.79 (0.37-8.61)
Proton pump inhibitors	1.5316	0.0306¹	0.2	4.63 (1.15-18.53)	2.5465	0.0053¹	0.29	12.76 (2.13-76.52)
Blood test results
Hemoglobin (g/dL)	−0.012	0.9458	0	0.99 (0.70-1.39)
Albumin (g/dL)	−1.429	0.0951	−0.11	0.24 (0.04-1.28)
Bilirubin (mg/dL)	0.1916	0.3572	0	1.21 (0.81-1.82)

¹P < 0.05. Hazard risk ratios were calculated using a Cox proportional hazard model. HR: Hazard risk ratio; GFV: Gastric fundal varices; EIS: Endoscopic injection sclerotherapy; NSAIDs: Nonsteroidal anti-inflammatory drugs.

Table 3 Factors associated with overall survival related to gastric fundal variceal bleeding

Parameters	Univariate analysis				Multivariate analysis
Parameters	β	P value	R	HR (95%CI)	β	P value	R	HR (95%CI)
Sex (F/M)	0.1107	0.8404	0	1.12 (0.38-3.28)
Age (yr)	0.0152	0.5056	0	0.98 (0.94-1.03)
History
Smoking	0.5678	0.3014	0	1.76 (0.60-5.18)
Alcohol	0.3031	0.5591	0	1.35 (0.49-3.74)
Disease conditions
Child-Pugh classification (C/B/A)	0.9924	0.0366¹	0.15	2.70 (1.06-6.84)
Hepatocellular carcinoma	1.8351	0.0013¹	0.29	6.27 (2.05-19.17)	2.0666	0.0035¹	0.26	7.89 (1.98-31.58)
Hepatic encephalopathy	0.5089	0.4391	0	1.66 (0.46-6.04)
Form of GFV (F2 or F3/F1)	0.3475	0.7379	0	1.42 (0.18-10.85)
Concurrent esophageal varices	−0.098	0.8596	0	0.91 (0.31-2.67)
Etiology of liver cirrhosis (non-viral/viral)	−0.086	0.8688	0	0.92 (0.33-2.54)
Treatment of GFV
Success of initial treatment	−2.176	0.0081¹	−0.22	0.11 (0.02-0.57)
Initial treatment (non-EIS/EIS/none)	0.0496	0.9356	0	1.05 (0.32-3.50)
Antibiotics	−0.81	0.0512	−0.07	0.44 (0.16-1.25)	−1.3103	0.0341¹	−0.16	0.27 (0.08-0.91)
Blood transfusion	0.5432	0.6012	0	1.72 (0.22-13.18)
Rebleeding after initial treatment	1.3669	0.0087¹	0.22	3.92 (1.41-10.89)
Medications administered before admission
NSAIDs	1.0131	0.0877	0.1	2.75 (0.86-8.81)	1.2391	0.1184	0.07	3.45 (0.73-16.35)
Proton pump inhibitors	1.4012	0.0084¹	0.22	4.06 (1.43-11.52)	2.3901	0.0005¹	0.32	10.91 (2.86-41.65)
Blood test results
Hemoglobin (g/dL)	−0.062	0.6398	0	0.94 (0.72-1.22)
Albumin (g/dL)	−1.081	0.0915	−0.09	0.34 (0.10-1.19)
Bilirubin (mg/dL)	0.3065	0.0514	0.13	1.36 (0.99-1.85)	0.4224	0.0535	0.13	1.53 (0.99-2.34)

¹P < 0.05. Hazard risk ratios calculated using a Cox proportional hazard model. GFV: Gastric fundal varices; EIS: Endoscopic injection sclerotherapy; NSAIDs: Nonsteroidal anti-inflammatory drugs.

Table 4 Baseline characteristics of patients with gastric fundal variceal bleeding in the antibiotic vs nonantibiotic group

Parameters	Antibiotic group	Non-antibiotic group	P value
Parameters	(n = 23)	(n = 19)	P value
Sex ratio (F/M)	5/18	8/11	0.1925
Mean age (yr)	64.4 ± 13.07	65.47 ± 9.83	0.7673
History
Smoking (presence/absence)	12/11	9/10	1
Alcohol (presence/absence)	12/11	8/11	0.5512
Disease conditions
Child-Pugh classification (A/B/C)	2/13/8	2/7/10	NA
Hepatocellular carcinoma (presence/absence)	7/16	7/12	0.7483
Hepatic encephalopathy (presence/absence)	1/22	5/14	0.0754
Form of gastric fundal varices ( F2-F3/F1)	21/2	17/2	1
Concurrent esophageal varices (presence/absence)	17/6	13/6	0.7422
Previous treatment of GV (presence/absence)	0/23	1/18	0.4524
Etiology of liver cirrhosis
Non-viral/viral	9/14	10/9	0.5347
Treatment of gastric fundal varices
Success of initial treatment (success/failure)	22/1	17/2	0.5813
Antibiotics (presence/absence)	23/0	0/19	< 0.0001^a
Blood transfusion (presence/absence)	22/1	16/3	0.3129
Medications before admission
NSAIDs (presence/absence)	2/21	3/16	0.6440
Anticoagulant (presence/absence)	0/23	1/18	0.4524
Proton pump inhibitors (presence/absence)	8/15	6/13	1
Blood test results
Hemoglobin (g/dL)	8.97 ± 1.99	8.30 ± 1.63	0.2472
Albumin (g/dL)	2.56 ± 0.47	2.50 ± 0.39	0.6125
Bilirubin (mg/dL)	1.89 ± 1.41	2.09 ± 1.49	0.6616

Antibiotic group: patients with gastric fundal variceal (GFV) bleeding who were administered prophylactic antibiotics; Nonantibiotic group: patients with GFV bleeding patients who did not receive antibiotics.

^aP < 0.05. NA: Not applicable; GV: Gastric varices; NSAIDs: Nonsteroidal anti-inflammatory drugs.

Table 5 Baseline demographics and characteristics of patients in the proton pump inhibitors vs non- proton pump inhibitors group

Parameters	PPI group	Non-PPI group	P value
Parameters	(n = 14)	(n = 28)	P value
Sex ratio (F/M)	6/8	7/21	0.2980
Mean age (yr)	61.9 ± 13.36	66.4 ± 10.53	0.2364
History
Smoking (presence/absence)	8/6	13/15	0.7442
Alcohol (presence/absence)	7/7	13/15	1
Disease conditions
Child-Pugh classification (A/B/C)	0/6/8	4/14/10	0.2122
Hepatocellular carcinoma (presence/absence)	6/8	8/20	0.4899
Hepatic encephalopathy (presence/absence)	2/12	4/24	1
Form of gastric fundal varices (F2-F3/F1)	2/12	2/26	0.5902
Concurrent esophageal varices (presence/absence)	7/7	23/5	0.0666
Previous treatment of GV (presence/absence)	0/14	1/27	1
Etiology of liver cirrhosis
Non-viral/viral	4/10	15/13	0.1905
Treatment of gastric fundal varices
Success of initial treatment (success/failure)	12/2	27/1	0.2537
Antibiotics (presence/absence)	8/6	15/13	1
Blood transfusion (presence/absence)	13/1	25/3	1
Medications before admission
NSAIDs (presence/absence)	4/24	1/13	0.6496
Anticoagulants (presence/absence)	1/13	0/28	0.3333
Proton pump inhibitors (presence/absence)	14/0	0/28	< 0.0001^a
Blood test results
Hemoglobin (g/dL)	8.65 ± 1.59	8.68 ± 1.99	0.4792
Albumin (g/dL)	2.34 ± 0.39	2.64 ± 0.43	0.0314^a
Bilirubin (mg/dL)	2.00 ± 1.39	1.97 ± 1.48	0.5238

PPI group: patients with gastric fundal variceal (GFV) bleeding who were administered proton pump inhibitors; Non-PPI group: patients with GFV bleeding who did not receive proton pump inhibitors.

^aP < 0.05. NA: Not applicable; GV: Gastric varices; NSAIDs: Nonsteroidal anti-inflammatory drugs; PPI: Proton pump inhibitors.

Citation: Komori K, Kubokawa M, Ihara E, Akahoshi K, Nakamura K, Motomura K, Masumoto A. Prognostic factors associated with mortality in patients with gastric fundal variceal bleeding. World J Gastroenterol 2017; 23(3): 496-504
URL: https://www.wjgnet.com/1007-9327/full/v23/i3/496.htm
DOI: https://dx.doi.org/10.3748/wjg.v23.i3.496