Risk factors for early rebleeding after first-time endoscopic variceal ligation

Objective To investigate the effect of endoscopic variceal ligation ( EVL) for the first time on liver function in patients with liver cirrhosis and the risk factors for early rebleeding after surgery. Methods A retrospective analysis was performed for the clinical data of 125 cirrhotic patients with esophageal varices who underwent EVL in China-Japan Union Hospital of Jilin University from December 2013 to December 2016. They were divided into different groups according to Child-Pugh score. Liver function was observed before EVL and at 1 week after EVL. The features of patients who experienced early rebleeding after EVL were analyzed. The t-test was used for comparison of normally distributed continuous data between two groups, and a one-way analysis of variance was used for comparison between multiple groups; the Wilcoxon test was used for comparison of non-normally distributed continuous data between two groups. The chi-square test was used for comparison of categorical data between groups. The Cox regression model was used to analyze the risk factors for postoperative bleeding, the Kaplan-Meier curve was used to analyze the association of observation indices with postoperative bleeding, and the log-rank test was used for difference analysis. Results There were no significant differences in liver function parameters between the patients with different Child-Pugh classes before and after EVL ( all P > 0. 05) . Of all 125 patients, 11 experienced early rebleeding, resulting in an early rebleeding rate of8. 8%. The univariate Cox regression analysis showed that there were significant differences in hemoglobin, prothrombin time ( PT) , aspartate aminotransferase, total bilirubin, albumin, the presence or absence of portal vein thrombosis, amount of ascites, and liver function classification between the patients with bleeding and those without ( all P < 0. 05) . The multivariate Cox regression analysis showed that Child-Pugh class C ( hazard ratio [HR]= 6. 363, 95% confidence interval [CI]: 1. 629-26. 580, P = 0. 021) , amount of ascites ( small: HR = 6. 581, 95% CI: 1. 060-66. 681, P = 0. 046; middle/large: HR = 8. 447, 95% CI: 1. 763-11. 641, P = 0. 022) , long PT before surgery ( HR =1. 146, 95% CI: 1. 039-1. 264, P = 0. 006) , and the presence of portal vein thrombosis ( HR = 9. 691, 95% CI: 1. 185-19. 281, P = 0. 034) were independent risk factors for early rebleeding after EVL. The Kaplan-Meier curve analysis was performed for the results of the multivariate Cox regression analysis, and the results showed that Child-Pugh class C ( χ2= 3. 972, P = 0. 046) , presence of ascites ( χ2= 20. 916, P <0. 001) , prolonged PT ( χ2= 21. 302, P < 0. 001) , and presence of portal vein thrombosis ( χ2= 10. 608, P = 0. 001) were risk factors for early rebleeding after EVL. Conclusion EVL does not cause damage to patients' liver function within a short period of time and is safe and effective. Liver function should be corrected, the amount of ascites should be reduced, and coagulation function should be improved before surgery to reduce the incidence rate of early rebleeding after EVL.