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Clinical significance of variceal hemorrhage in recent years in patients with liver cirrhosis and esophageal varices
Author(s) -
PARK DONG KYU,
UM SOON HO,
LEE JAE WON,
LEE JUNG BOK,
KIM YOUNG SUN,
PARK CHUL HEE,
JIN YOON TAE,
CHUN HOON JAI,
LEE HONG SIK,
LEE SANG WOO,
CHOI JAI HYUN,
KIM CHANG DUCK,
RYU HO SANG,
HYUN JIN HAI
Publication year - 2004
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2004.03383.x
Subject(s) - medicine , esophageal varices , cirrhosis , gastroenterology , varices , ascites , hepatocellular carcinoma , portal hypertension , retrospective cohort study , hepatic encephalopathy , gastric varices , liver function , cohort
Background and Aims: Recent progress in the treatment of variceal bleeding might have reduced the impact of variceal bleeding on survival in patients with esophageal varices. We conducted a retrospective cohort study in an attempt to re‐evaluate the clinical significance of variceal bleeding. Methods: A cohort of 304 patients with liver cirrhosis and esophageal varices, who had no previous history of variceal bleeding and no prophylactic therapy, was studied. Results: During a median follow‐up period of 32 months, 55 patients (18%) bled from varices and 111 (37%) died. Variceal hemorrhages accounted for 15% of total deaths. The mortality of first variceal bleeding was 25% in the whole group, but was remarkably different depending on liver function at the time of bleeding (0% in grade Child A vs 55% in grade C; P < 0.05). Among the survivors of first bleeding, 30% experienced rebleeding. Form of varix, red color sign and heavy drinking were the independent risk factors for first variceal bleeding. Multivariate analysis revealed that variceal bleeding still had a significant ( P < 0.001) impact on death in the whole cohort, when other independent prognostic factors such as age, ascites, encephalopathy, platelet count, serum albumin level and hepatocellular carcinoma were adjusted. Furthermore, in subgroup analyses, variceal bleeding was more strongly ( P < 0.001) linked to death in patients with alcoholic cirrhosis than in those with non‐alcoholic cirrhosis, and showed a significant association with survival only for the patients in Child grade B. Conclusions: Variceal bleeding has various prognostic impacts depending on the etiology of cirrhosis or on the degree of liver dysfunction, and this needs to be taken into account in the prophylaxis against first variceal bleeding.