中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 6
Jun.  2021
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(6): 1326-1330

Rebleeding and prognosis of patients with liver cirrhosis and severe esophagogastric variceal bleeding

DOI: 10.3969/j.issn.1001-5256.2021.06.022

  • Third Central Clinical College, Tianjin Medical University; Department of Gastroenterology and Hepatology, Tianjin Third Central Hospital; Tianjin Institute of Hepatobiliary Disease; Artificial Cell Engineering Technology Research Center, Tianjin 300170, China

  • Received Date: 2020-11-14
  • Accepted Date: 2020-12-22
  • Published Date: 2021-06-20
    Abstract
  •   Objective  To investigate the risk factors for rebleeding within 5 years and the influencing factors for 5-year survival in patients with liver cirrhosis and severe esophagogastric variceal bleeding (EVB).  Methods  A retrospective analysis was performed for 129 patients with liver cirrhosis who attended Tianjin Third Central Hospital from May 2012 to May 2014 due to severe EVB for the first time, with a follow-up time of 5 years. Related clinical data were analyzed, including age, sex, cause of liver cirrhosis, presence or absence of infection at the first time of bleeding, liver stiffness measurement (LSM), splenic stiffness measurement (SSM), portal vein diameter, biochemical parameters, rebleeding time, and prognosis. Esophagogastric variceal rebleeding was defined as the primary endpoint and death was defined as the secondary endpoint. The t-test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups; a logistic regression analysis was used to investigate the independent risk factors for rebleeding, and a Cox regression analysis was used to analyze the predictive indicators for 5-year survival in EVB patients; the Kaplan-Meier curve was used to analyze the cumulative non-rebleeding rate.  Results  Among the 129 patients, 87(67.4%) experienced rebleeding during follow-up. There were significant differences between the rebleeding group and the non-rebleeding group in the proportion of patients with alcoholic cirrhosis (χ2=4.896, P=0.027), portal vein diameter (t=2.203, P=0.030), LSM(Z=-2.771, P=0.006), and SSM(t=2.678, P=0.010). The patients with alcoholic cirrhosis had a significantly higher mean number of times of bleeding than those with non-alcoholic cirrhosis (all P < 0.05). The multivariate logistic regression analysis showed that alcoholic cirrhosis (odds ratio [OR]=5.687, 95% confidence interval [CI]: 1.230-26.129, P=0.025), LSM(OR=1.039, 95% CI: 1.010-1.070, P=0.007), and SSM(OR=1.078, 95% CI: 1.028-1.129, P=0.001) were independent risk factors for rebleeding within 5 years after treatment in EVB patients. Among the 129 patients, 45 (34.9%) died. The univariate Cox regression analysis showed that there were significant differences between the death group and the survival group in age, times of bleeding, mean arterial pressure, portal vein diameter, aspartate aminotransferase, lymphocyte percentage, and presence or absence of infection at the first time of bleeding (all P < 0.05). Further multivariate analysis showed that 5-year survival rate was associated with portal vein diameter (OR=1.459, 95% CI: 1.056-2.014, P=0.022), age (OR=1.053, 95% CI: 1.006-1.103, P=0.026), times of bleeding (OR=1.286, 95% CI: 1.040-1.591, P=0.020), and presence or absence of infection at the first time of bleeding (OR=5.239, 95% CI: 1.750-15.641, P=0.003).  Conclusion  Alcoholic cirrhosis, LSM, and SSM are independent risk factors for rebleeding within 5 years in EVB patients, and age, times of bleeding, portal vein diameter, and presence or absence of infection at the first time of bleeding are associated with 5-year survival.

     

    • FullText(HTML)
  • loading
    • References(23)
  • [1]
    GARCIA-TSAO G, ABRALDES JG, BERZIGOTTI A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases[J]. Hepatology, 2017, 65(1): 310-335. DOI: 10.1002/hep.28906.
    [2]
    Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Endoscopy, Chinese Medical Association. Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J]. J Clin Hepatol, 2016, 32(2): 203-219. DOI: 10.3969/j.issn.1001-5256.2016.02.002.

    中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]. 临床肝胆病杂志, 2016, 32(2): 203-219. DOI: 10.3969/j.issn.1001-5256.2016.02.002.
    [3]
    BOSCH J, GARCíA-PAGÁN JC. Prevention of variceal rebleeding[J]. Lancet, 361(9361): 952-954. DOI: 10.1016/S0140-6736(03)12778-X.
    [4]
    de FRANCHIS R, BAVENO VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension[J]. J Hepatol, 2015, 63(3): 743-752. DOI: 10.1016/j.jhep.2015.05.022.
    [5]
    Chinese Society of Hepatology, Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.

    中华医学会肝病学分会. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.
    [6]
    Committee of Esophageal Varicosity, Society of Digestive Endoscopy Chinese Medical Association. Tentative guidelines endoscopic diagnosis and treatment of varicosity and variceal bleeding in digestive tract (2009)[J]. Chin J Dig Endosc, 2010, 27(1): 1-4. DOI: 10.3760/cma.j.issn.1007-5232.2010.01.001.

    中华医学会消化内镜学分会食管胃静脉曲张学组. 消化道静脉曲张及出血的内镜诊断和治疗规范试行方案(2009年)[J]. 中华消化内镜杂志, 2010, 27(1): 1-4. DOI: 10.3760/cma.j.issn.1007-5232.2010.01.001.
    [7]
    SHARMA P, SARIN SK. Improved survival with the patients with variceal bleed[J]. Int J Hepatol, 2011, 2011: 356919. DOI: 10.4061/2011/356919.
    [8]
    Chinese Portal Hypertension Diagnosis and Monitoring Study Group(CHESS); Minimally Invasive Intervention Collaborative Group, Chinese Society of Gastroenterology; Emergency Intervention Committee, Chinese College of Interventionalists, et al. Consensus on clinical application of hepatic venous pressure gradient in China (2018)[J]. J Clin Hepatol, 2018, 34(12): 2526-2536. DOI: 10.3969/j.issn.1001-5256.2018.12.008

    中国门静脉高压诊断与监测研究组(CHESS), 中华医学会消化病学分会微创介入协作组, 中国医师协会介入医师分会急诊介入专业委员会, 等. 中国肝静脉压力梯度临床应用专家共识(2018版)[J]. 临床肝胆病杂志, 2018, 34(12): 2526-2536. DOI: 10.3969/j.issn.1001-5256.2018.12.008
    [9]
    ABD EL RIHIM AY, OMAR RF, FATHALAH W, et al. Role of fibroscan and APRI in detection of liver fibrosis: A systematic review and meta-analysis[J]. Arab J Gastroenterol, 2013, 14(2): 44-50. DOI: 10.1016/j.ajg.2013.05.002.
    [10]
    BUREAU C, METIVIER S, PERON JM, et al. Transient elastography accurately predicts presence of significant portal hypertension in patients with chronic liver disease[J]. Aliment Pharmacol Ther, 2008, 27(12): 1261-1268. DOI: 10.1111/j.1365-2036.2008.03701.x.
    [11]
    LIU F, LI TH, HAN T, et al. Non-invasive assessment of portal hypertension in patients with liver cirrhosis using FibroScan transient elastography[J]. Chin J Hepatol, 2013, 21(11): 840- 844. DOI: 10.3760/cma.j.issn.1007-3418.2013.11.010.

    刘芳, 李庭红, 韩涛, 等. 瞬时弹性成像在肝硬化门静脉高压中的临床评价[J]. 中华肝脏病杂志, 2013, 21(11): 840-844. DOI: 10.3760/cma.j.issn.1007-3418.2013.11.010.
    [12]
    LI TH, LIU F, HAN T, et al. Noninvasive assessment of esophageal-gastric varices by spleen stiffiness liver cirrhosis patients[J]. Chin J Infect, 2012, 30(10): 603-608. DOI: 10.3760/cma.j.issn.1000-6680.2012.10.006.

    李庭红, 刘芳, 韩涛, 等. 脾脏硬度对肝硬化患者食管胃底静脉曲张的评估[J]. 中华传染病杂志, 2012, 30(10): 603-608. DOI: 10.3760/cma.j.issn.1000-6680.2012.10.006.
    [13]
    COLECCHIA A, MONTRONE L, SCAIOLI E, et al. Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis[J]. Gastroenterology, 2012, 143(3): 646-654. DOI: 10.1053/j.gastro.2012.05.035.
    [14]
    TAKUMA Y, NOUSO K, MORIMOTO Y, et al. Portal hypertension in patients with liver cirrhosis: Diagnostic accuracy of spleen stiffness[J]. Radiology, 2016, 279(2): 609-619. DOI: 10.1148/radiol.2015150690.
    [15]
    SHARMA P, KIRNAKE V, TYAGI P, et al. Spleen stiffness in patients with cirrhosis in predicting esophageal varices[J]. Am J Gastroenterol, 2013, 108(7): 1101-1107. DOI: 10.1038/ajg.2013.119.
    [16]
    NILLES KM, FLAMM SL. Thrombocytopenia in chronic liver disease: New management strategies[J]. Clin Liver Dis, 2020, 24(3): 437-451. DOI: 10.1016/j.cld.2020.04.009.
    [17]
    MEJIAS M, GARCIA-PRAS E, GALLEGO J, et al. Relevance of the mTOR signaling pathway in the pathophysiology of splenomegaly in rats with chronic portal hypertension[J]. J Hepatol, 2010, 52(4): 529-539. DOI: 10.1016/j.jhep.2010.01.004.
    [18]
    LAMEIRÄO GOMES C, VIOLANTE SILVA R, CARROLA P, et al. Bacterial infections in patients with liver cirrhosis in an internal medicine department[J]. GE Port J Gastroenterol, 2019, 26(5): 324-332. DOI: 10.1159/000494568.
    [19]
    GELETO G, GETNET W, TEWELDE T. Mean normal portal vein diameter using sonography among clients coming to radiology department of Jimma university hospital, Southwest Ethiopia[J]. Ethiop J Health Sci, 2016, 26(3): 237-242. DOI: 10.4314/ejhs.v26i3.6.
    [20]
    TANEJA SK, DHIMAN RK. Prevention and management of bacterial infections in cirrhosis[J]. Int J Hepatol, 2011, 2011: 784540. DOI: 10.4061/2011/784540.
    [21]
    Ali A, Swingland J, Choi CH, et al. OC-143 Artificial neural network for the risk stratification of acute upper gastrointestinal bleeding: multicentre comparative analysis vs the Glasgow Blatchford and rockall scores[J]. Gut, 2012, 61(Suppl 2): A62. DOI: 10.1136/gutjnl-2012-302514a.143.
    [22]
    FERNANDEZ J, ARROYO V. Bacterial infections in cirrhosis: A growing problem with significant implications[J]. Clin Liver Dis (Hoboken), 2013, 2(3): 102-105. DOI: 10.1002/cld.169.
    [23]
    PARK EJ, JANG JY, LEE JE, et al. The risk factors for bleeding of fundal varices in patients with liver cirrhosis[J]. Gut Liver, 2013, 7(6): 704-711. DOI: 10.5009/gnl.2013.7.6.704.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(1)  / Tables(3)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (561) PDF downloads(61) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return