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Variceal hemorrhage: Analysis of 9987 cases from a J apanese nationwide database
Author(s) -
Sato Masaya,
Tateishi Ryosuke,
Yasunaga Hideo,
Horiguchi Hiromasa,
Yoshida Haruhiko,
Fushimi Kiyohide,
Koike Kazuhiko
Publication year - 2015
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.12357
Subject(s) - medicine , univariate analysis , logistic regression , multivariate analysis , odds ratio , comorbidity , cirrhosis , univariate , database , population , multivariate statistics , gastroenterology , statistics , mathematics , environmental health , computer science
Aim Gastroesophageal variceal hemorrhage is an important complication of cirrhosis. We investigated the in‐hospital mortality and its risk factors after variceal hemorrhage in a large sample population, using a nationwide Japanese database. Methods Data on the patients with variceal hemorrhage were collected for a total of 39 months from a nationwide administrative database covering approximately 1000 hospitals in J apan. The risk factors for fatal outcome after variceal hemorrhage were analyzed with receiver–operator curves ( ROC ) and univariate and multivariate logistic regression. Comorbidities were assessed with the C harlson C omorbidity I ndex. Results We identified 9987 patients with variceal hemorrhage from a total of 20.3 million inpatients in the database. The median age was 63 years and 68.8% were male. The overall in‐hospital mortality was 16.8% (1676 cases). In univariate analysis, C hild– P ugh class was the strongest predictor; the area under the ROC of C hild– P ugh score for predicting in‐hospital mortality was 0.802. In multivariate analysis, increased in‐hospital mortality was significantly associated with male sex (vs female: odds ratio [ OR ] = 1.19, P = 0.01), older age, C hild– P ugh class B or C ( B vs A : OR = 2.80, P < 0.001; C vs A : OR = 20.1, P < 0.001) and higher C harlson C omorbidity I ndex (≥6 vs ≤5; OR = 1.29, P < 0.001). Conclusion In spite of recent advances in the treatment of variceal hemorrhage, the in‐hospital mortality remained as high as 16%. Poor liver function was the most important predictor, suggesting that liver failure after variceal hemorrhage might have been the cause of death.