Risk factors for early rebleeding after esophageal variceal ligation in patients with liver cirrhosis

Objective To investigate the risk factors for early rebleeding after esophageal variceal ligation (EVL) in patients with liver cirrhosis.Methods A retrospective analysis was performed for the clinical data of 506 cirrhotic patients with esophageal varices who were admitted to Shaanxi Provincial People's Hospital from January 2000 to May 2016 and underwent EVL, and according to the presence or absence of early rebleeding after surgery, these patients were divided into bleeding group with 38 patients and non-bleeding group with 468 patients.The factors that could lead to postoperative rebleeding were collected.The t-test was used for comparison of normally distributed continuous data between groups, and the chi-square test was used for comparison of categorical data.An unconditional multivariate logistic regression analysis was used to investigate independent risk factors.Results The univariate analysis showed that there were significant differences between the two groups in sex (χ2=5.675) , number of times of hematemesis before treatment (t=1.335) , amount of hematemesis before treatment (χ2=1.983) , number of times of melena (t=2.984) , number of varicose veins (t=1.083) , serum prothrombin time (t=2.182) , prothrombin time activity (t=2.584) , albumin (Alb) (t=1.046) , total bilirubin (t=2.463) , aspartate transaminase (t=3.473) , severity of ascites (χ2=8.484) , Child-Pugh score (t=1.664) , Child-Pugh class (χ2=15.675) , number of ligation points (t=1.134) , and number of times of ligation (t=3.902) (all P<0.05) .The multivariate logistic regression analysis showed that male sex (odds ratio [OR]=1.598, 95% confidence interval [CI]:1.038-2.929) , Child-Pugh score>7.2 (OR=2.306, 95% CI:1.443-3.031) , and small, moderate, and large amounts of hematemesis before treatment (OR=1.342, 2.763, and 4.675, 95% CI:1.014-2.627, 1.356-4.122, and 2.321-6.929) were independent risk factors for early rebleeding after EVL (all P<0.05) , while Alb>31.5 g/L was a protective factor against early rebleeding after EVL (OR=0.411, 95% CI:0.288-0.641, P<0.05) .Conclusion Health education should be enhanced for male patients after EVL, and early correction of liver function and coagulation disorders, improvement of Alb level, prevention and treatment of ascites, and improvement in technical level of ligation may help to reduce the incidence rate of early rebleeding after EVL.