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CN 22-1108/R
Volume 40 Issue 7
Jul.  2024
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Article Navigation >  Journal of Clinical Hepatology  > 2024  >  40(7): 1375-1381

Influencing factors for rebleeding and 5-year survival rate after treatment in patients with liver cirrhosis and spontaneous splenorenal shunt

DOI: 10.12449/JCH240715
  • 1.

    Department of Gastroenterology，Xiamen Branch，Zhongshan Hospital，Fudan University，Xiamen，Fujian 361000，China

  • 2.

    Department of Gastroenterology，Zhongshan Hospital，Fudan University，Shanghai 200032，China

Research funding:

National Natural Science Foundation of China (82370622);

Key Project of Natural Science Foundation of Fujian Province (2021D033);

Medical Innovation Project of Fujian Province (2022CXB020);

Guiding Project of Medical and Health Care of Xiamen City (3502Z20209046)

More Information
  • Corresponding author: ZHENG Linlin， azll159@163.com （ORCID： 0000-0003-1660-9163）
  • Received Date: 2023-11-26
  • Accepted Date: 2023-12-26
  • Published Date: 2024-07-25
    Abstract
  •   Objective  To investigate the influencing factors for rebleeding and 5-year survival rate after treatment in patients with liver cirrhosis and spontaneous splenorenal shunt （SSRS）， and to provide a basis for clinical prognostic assessment.  Methods  A total of 95 patients with liver cirrhosis and SSRS who were admitted to Zhongshan Hospital and Xiamen Branch of Fudan University from June 2014 to June 2018 were enrolled， and all patients were followed up for at least 5 years. According to the presence or absence of gastrointestinal bleeding during follow-up， the patients were divided into rebleeding group with 27 patients and non-rebleeding group with 68 patients. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. Univariate and multivariate Cox regression analyses were used to investigate the influencing factors for the prognosis of patients with SSRS， and the Kaplan-Meier method was used to describe survival outcomes. A Pearson or Spearman correlation analysis was performed.  Results  Compared with the non-rebleeding group， the rebleeding group had significantly higher splenorenal shunt diameter ［4.60（3.20 ‍—‍ 5.90） mm vs 3.45（2.10 ‍—‍ 5.45） mm， Z=1.973， P=0.048］ and hepatic venous pressure gradient（18.57±6.60 mmHg vs 15.06±5.82 mmHg， t=2.280， P=0.026） and a significantly lower portal vein diameter（14.04±2.90 mm vs 15.45±2.90 mm， t=2.138， P=0.035）. The correlation analysis showed that splenorenal shunt diameter was negatively correlated with portal vein diameter（rs =-0.211， P=0.040）. Adverse events within 5 years after treatment included rebleeding（27.4%）， portal vein thrombosis（11.6%）， infection（4.2%）， cerebral hemorrhage（1.1%）， and cerebral infarction（1.1%）. Splenorenal shunt diameter（risk ratio ［RR］=1.173， 95% confidence interval ［CI］： 1.001‍ ‍—‍ ‍1.374， P=0.048） and superior mesenteric vein diameter（RR=0.844， 95%CI： 0.746 ‍—‍ 0.956， P=0.007） were independent influencing factors for gastrointestinal rebleeding within 5 years after treatment. Bilirubin（RR=1.028， 95%CI： 1.010 ‍—‍ 1.046， P=0.002） and blood urea nitrogen（RR=1.347， 95%CI： 1.116 ‍—‍ 1.625， P=0.002） were independent risk factors for 5-year survival rate after treatment.  Conclusion  Splenorenal shunt diameter is closely associated with the prognosis of cirrhotic patients， and it is recommended to enhance imaging follow-up of splenorenal shunt diameter for cirrhotic patients with SSRS.

     

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