Predictive Factors for Rebleeding and Death in Alcoholic Cirrhotic Patients with Acute Variceal Bleeding: A Multivariate Analysis

Krige, J. E. J.; Kotze, U.; Distiller, Greg; Shaw, John M.; Bornman, Philippus C.

doi:10.1007/s00268-009-0172-6

Cited by 45 publications

(38 citation statements)

References 72 publications

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“…Early rebleeding and mortality rate increase sharply within 6 weeks period then stabilized. Early rebleeding rate in the current study was 25.5%, a similar result reported by Krige et al [12] but it is slightly higher than that in some other studies [3] [13] while it is lower than that in other studies [14] [15].…”

Section: Discussionsupporting

confidence: 35%

Prediction of Early Rebleeding and Mortality after Acute Esophageal Variceal Hemorrhage among Yemeni Patients in Major Hospitals—Sana’a

Hunaysh¹

2016

OJGas

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Background and aims: Acute variceal hemorrhage (AVH) is the most serious encountered complication of liver cirrhosis and carries high mortality rate. Several risk factors that predict early rebleeding and mortality have been studied and there is no similar study in our country, so the aim of this study was to identify the risk factors of early rebleeding and mortality after bleeding episode in cirrhotic patients in Yemen. Patients and Method: It was a prospective study of cirrhotic patients with AVH who were admitted to the main public hospitals in Sana'a between April 2014 and March 2015. Demographic information, medical histories, physical examination findings, and laboratory test results were collected. Endoscopic and pharmacologic treatment was performed. The patients were followed up since admission and up to 6 weeks for the occurrence of rebleeding and mortality after the acute attack. Univariate and multivariate analyses were performed to identify independent risk factors for rebleeding and mortality. Survival analysis was estimated using the Kaplan-Meier method. Result: A total of 102 patients were analyzed. 26 patients (25.5%) rebleeded within 6 weeks period. The predictive factors significantly associated with rebleeding within 6 weeks period in univariate analysis were clot on varix at index endo-scope (P < 0.0001), high serum bilirubin (P = 0.02), CTP score (P < 0.05) and MELD score (P < 0.05). Independent risks factors remained in multivariate analysis as significant predictors of early rebleeding were clot on varix (OR: 11.6, CI: 2.87 -47.29, P = 0.001) and high serum bilirubin (>3) (OR: 1.1, CI: 1.02 -1.19, P = 0.01). Sixteen patients died (15.7%) within 6 weeks period. Predictors of mortality with significant difference in univariate analysis were hypovolemic shock (P = 0.001), high WBCs count (P < 0.0001), low serum sodium (P = 0.04), high AST (P < 0.0001), high ALT (P = 0.02), high INR (P < 0.0001), high serum bilirubin (P < 0.0001), low serum albumin (P = 0.005), ascites (P = 0.001), A. Y. Hunaysh 215 CTP score (P < 0.0001) and MELD score (P < 0.0001). By multiple regression analysis high MELD score (≥19) (OR: 1.3, CI: 1.12 -1.41, P < 0.0001) and WBCs over 10.3 × 10 9 /l (OR: 1.2, CI: 1.02 -1.40, P < 0.05) were independent risk factors for mortality within 6 weeks period. Conclusion: Early rebleeding in cirrhotic patients with AVH was associated with clot on varix at endoscope and high serum bilirubin more than 3 mg/dl. Early mortality rate was associated with high MELD score (≥19) and WBCs over 10.3 × 10 9 /l.

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Section: Discussionsupporting

confidence: 35%

Prediction of Early Rebleeding and Mortality after Acute Esophageal Variceal Hemorrhage among Yemeni Patients in Major Hospitals—Sana’a

Hunaysh¹

2016

OJGas

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“…Table (5) compares the studied groups as regards rate and causes of rebleeding and mortality rate and shows that there were no significant differences between them. Correlation between the rate of rebleeding and study parameters revealed that the rate of rebleeding has significant positive correlation with Child's score, PT, INR, grade of OV, presence of risky signs, number of units of blood transfused during resuscitation, amount of sclerosing agent and number of rubber bands used as shown in table (6). …”

Section: Resultsmentioning

confidence: 99%

“…The risk of rebleeding is greatest during the first few days after initial variceal hemorrhage [5]. Survival after variceal bleeding depends largely on the rapidity and efficacy of initial primary hemostasis and the presence and severity of underlying liver disease and hepatic functional reserve [6].…”

Section: Introductionmentioning

confidence: 99%

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Different Factors Correlated to Early Rebleeding in Cirrhotic Patients Treated by Variceal Band ligation versus Endoscopic Sclerotherapy

Amer

Jouda

Monem

2016

Afro-Egyptian Journal of Infectious and Endemic Diseases

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“…L'hémostase primaire dans les deux groupes de patients (ulcères hémorragiques et ruptures des varices oesogastriques) était similaire aux résultats rapportés dans la littérature [36][37][38].…”

Section: Discussionunclassified

Épidémiologie des hémorragies digestives hautes en Tunisie

et al. 2010

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L'hémorragie digestive haute demeure une cause fréquente d'hospitalisation, de morbidité et de mortalité. Les études épidémiologiques sont limitées dans notre pays. But : Déterminer les causes et l'évolution des patients ayant une hémorragie digestive haute, colligés au CHU de Monastir. Matériels et méthodes : Les dossiers de 874 patients qui ont subi une endoscopie digestive haute pour hémorragie digestive pendant une durée de dix ans (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007) ont été rétro-spectivement analysés. Résultats : Les 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 hémor-ragique. Trente-six patients étaient décédés (4,1 %). Conclusion : L'ulcère hémorragique est la cause la plus fré-quente 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'hémor-ragie digestive haute peuvent être traités par hémostase endoscopique, quand l'endoscopie diagnostique établit la source. Mots clésHémorragie digestive haute · Ulcère gastroduodénal · Gastroduodénite hémorragique · Endoscopie Abstract Background: Acute 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 objectives: The aim of this study is to determine the causes and outcome of patients with UGIB presenting at the teaching hospital of Monastir. Materials and methods: The 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)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007) were retrospectively analysed. Results: The 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 case...

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Predictive Factors for Rebleeding and Death in Alcoholic Cirrhotic Patients with Acute Variceal Bleeding: A Multivariate Analysis

Cited by 45 publications

References 72 publications

Prediction of Early Rebleeding and Mortality after Acute Esophageal Variceal Hemorrhage among Yemeni Patients in Major Hospitals—Sana’a

Prediction of Early Rebleeding and Mortality after Acute Esophageal Variceal Hemorrhage among Yemeni Patients in Major Hospitals—Sana’a

Different Factors Correlated to Early Rebleeding in Cirrhotic Patients Treated by Variceal Band ligation versus Endoscopic Sclerotherapy

Épidémiologie des hémorragies digestives hautes en Tunisie

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