Premium
Timing of the first variceal hemorrhage in cirrhotic patients: Prospective evaluation of doppler flowmetry, endoscopy and clinical parameters
Author(s) -
Siringo Sebastiano,
Bolondi Luigi,
Gaiani Stefano,
Sofia Soccorsa,
Zironi Gianni,
Rigamonti Alessandra,
Febo Giulio Di,
Miglioli Mario,
Cavalli Giancarlo,
Barbara Luigi
Publication year - 1994
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.1840200111
Subject(s) - medicine , hepatology , gastroenterology , esophageal varices , endoscopy , prospective cohort study , varix , laser doppler velocimetry , ultrasound , portal hypertension , radiology , blood flow , cirrhosis
We followed 87 cirrhotic patients with esophageal varices and without previous hemorrhage for a mean period of 24 mo to prospectively evaluate the occurrence of variceal bleeding within (early) or after (late) 6 mo from entry and the contribution of portal Doppler ultrasound parameters to the prediction of early and late hemorrhage. Clinical, biochemical, endoscopic and portal Doppler ultrasound parameters were recorded at entry. Variceal bleeding occurred in 22 patients (25.3%). Nine (40.9%) bled within the first 6 mo. Cox regression analysis identified variceal size, cherry‐red spots, serum bilirubin and congestion index of the portal vein (the ratio of portal vein [cross‐sectional area] and portal blood flow velocity) as the only independent predictors of first variceal hemorrhage. Discriminant analysis was used to find the prognostic index cut off points to identify patients who bled within 6 mo (prognostic group 1) or after 6 mo (prognostic group 2) or remained free of bleeding (prognostic group 3). The cumulative proportion of patients correctly classified was 73% in prognostic group 1,47% in prognostic group 2 and more than 80% in prognostic group 3. The addition of Doppler ultrasound flowmetry to clinical, biochemical and endoscopic parameter only improved the classification of patients with early bleeding. (Hepatology 1994;20:66–73.)