Influencing factors of rebleeding after gastroscopy in patients with liver cirrhosis and esophagogastric variceal bleeding

Jia LIAN; Tao HAN; Huiling XIANG; Yankai YANG; Tinghong LI; Lei LIU; Baiguo XU; Lixia SUN; Fei WANG; Yanchao FU

doi:10.3969/j.issn.1001-5256.2021.09.018

Volume 37 Issue 9

Sep. 2021

Turn off MathJax

Article Contents

Abstract

References

Article Navigation > Journal of Clinical Hepatology > 2021 > 37(9): 2092-2096

PDF( 2088 KB)

Influencing factors of rebleeding after gastroscopy in patients with liver cirrhosis and esophagogastric variceal bleeding

DOI: 10.3969/j.issn.1001-5256.2021.09.018

Department of Hepatology, Tianjin Third Central Hospital; The Third Central Clinical College of Tianjin Medical University; Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China

Research funding:

National Science and Technology Major Project on Prevention and Treatment of Major Infectious Diseases Including AIDS and Viral Hepatitis (2017ZX10203202)

Received Date: 2021-01-20
Accepted Date: 2021-04-06
Published Date: 2021-09-20

Abstract

Abstract

Objective To investigate the influencing factors for rebleeding after gastroscopy in patients with liver cirrhosis and esophagogastric variceal bleeding. Methods A retrospective analysis was performed for the clinical data of the patients with liver cirrhosis and esophagogastric variceal bleeding who were hospitalized in Tianjin Third Central Hospital from January 1, 2017 to December 31, 2018, and according to the presence or absence of rebleeding and bleeding time, the patients were divided into non-bleeding group (n=148) and bleeding group (n=119). The risk factors for rebleeding after gastroscopy were analyzed. The t-test or the Mann-Whitney U 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. The Cox regression model was used for univariate and multivariate analyses. The receiver operating characteristic (ROC) curve was used to evaluate the accuracy of Child-Turcotte-Pugh (CTP), fibrosis-4 (FIB-4), and albumin-bilirubin (ALBI) scores in predicting rebleeding after gastroscopy, and MedCalc was used to compare the area under the ROC curve (AUC). Results A total of 267 patients with liver cirrhosis and esophagogastric variceal bleeding were enrolled, among whom 53 (19.9%) had liver cancer. A total of 119 patients suffered from rebleeding, with an overall rebleeding rate of 44.6% and a median time to rebleeding of 11.0 (0-39.0) months. The univariate Cox regression analysis showed that liver cancer (hazard ratio [HR]=0.377, P < 0.001), aspartate aminotransferase (AST) (HR=1.002, P=0.025), serum Na (HR=0.935, P=0.004), and FIB-4 (HR=1.030, P=0.049) were associated with rebleeding, and the multivariate Cox regression analysis showed that liver cancer (HR=0.357, P < 0.001), AST (HR=1.003, P=0.030), prothrombin time (PT) (HR=0.196, P=0.001), CTP score (HR=1.289, P=0.014), FIB-4 (HR=1.062, P=0.033), and ALBI score (HR=0.433, P=0.011) were independent risk factors for rebleeding. CTP, FIB-4, and ALBI scores had an AUC of 0.711 (95% confidence interval [CI]: 0.647-0.776), 0.705 (95% CI: 0.640-0.770), and 0.730 (95% CI: 0.667-0.793), respectively, in predicting rebleeding. There was no significant difference in AUC between CTP, FIB-4, and ALBI scores (P > 0.05). Conclusion Liver cancer, AST, PT, CTP score, FIB-4 score, and ALBI score are associated with rebleeding after gastroscopy in patients with liver cirrhosis and esophagogastric variceal bleeding, among which CTP, FIB-4, and ALBI scores have a good value in predicting rebleeding outcome, while there is no significant difference in predictive ability between them.
- Liver Cirrhosis,
- Esophageal and Gastric Varices,
- Gastroscopy,
- Hemorrhage,
- Root Cause Analysis

FullText(HTML)

References(20)

References

[1]	Chinese Society of Spleen and Portal Hypertension Surgery, Chinese Society of Surgery, Chinese Medical Association. Expert consensus on diagnosis and treatment of esophagogastric variceal bleeding in cirrhotic portal hypertension(2019 edition)[J]. Chin J Pract Surg, 2019, 39(12): 1241-1247. DOI: 10.19538/j.cjps.issn1005-2208.2019.12.01. 中华医学会外科学分会脾及门静脉高压外科学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版)[J]. 中国实用外科杂志, 2019, 39(12): 1241-1247. DOI: 10.19538/j.cjps.issn1005-2208.2019.12.01.
[2]	BOSCH J, GARCÍA-PAGÁN JC. Prevention of variceal rebleeding[J]. Lancet, 2003, 361(9361): 952-954. DOI: 10.1016/S0140-6736(03)12778-X.
[3]	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.
[4]	REN LM, DANG T, MENG XM, et al. Analysis of risk factors for early rebleeding after endoscopic treatment of cirrhotic esophageal varices bleeding[J/C]. Chin J Gastrointestinal Endoscopy (Electronic Edition), 2019, 6(2): 57-61. DOI: 10.3877/cma.j.issn.2095-7157.2019.02.002. 任丽梅, 党彤, 孟宪梅, 等. 肝硬化食管静脉曲张出血内镜治疗后早期再出血的危险因素分析[J/CD]. 中华胃肠内镜电子杂志, 2019, 6(2): 57-61. DOI: 10.3877/cma.j.issn.2095-7157.2019.02.002.
[5]	ALTAMIRANO J, ZAPATA L, AGUSTIN S, et al. Predicting 6-week mortality after acute variceal bleeding: Role of classification and regression tree analysis[J]. Ann Hepatol, 2009, 8(4): 308-315. http://journals.indexcopernicus.com/fulltxt.php?ICID=900181
[6]	KRIGE JE, SHAW JM, BORNMAN PC, et al. Early rebleeding and death at 6 weeks in alcoholic cirrhotic patients with acute variceal bleeding treated with emergency endoscopic injection sclerotherapy[J]. S Afr J Surg, 2009, 47(3): 72-74, 76-79.
[7]	ROUT G, SHARMA S, GUNJAN D, et al. Development and validation of a novel model for outcomes in patients with cirrhosis and acute variceal bleeding[J]. Dig Dis Sci, 2019, 64(8): 2327-2337. DOI: 10.1007/s10620-019-05557-y.
[8]	HWANG JH, SHERGILL AK, ACOSTA RD, et al. The role of endoscopy in the management of variceal hemorrhage[J]. Gastrointest Endosc, 2014, 80(2): 221-227. DOI: 10.1016/j.gie.2013.07.023.
[9]	LEUNG JC, LOONG TC, PANG J, et al. Invasive and non-invasive assessment of portal hypertension[J]. Hepatol Int, 2018, 12(Suppl 1): 44-55. DOI: 10.1007/s12072-017-9795-0.
[10]	ZHOU SY, DUAN ZH. Noninvasive diagnosis of esophageal varices in liver cirrhosis[J]. J Clin Hepatol, 2020, 36(8): 1842-1846. DOI: 10.3969/j.issn.1001-5256.2020.08.036. 周胜云, 段志辉. 肝硬化食管静脉曲张的无创诊断[J]. 临床肝胆病杂志, 2020, 36(8): 1842-1846. DOI: 10.3969/j.issn.1001-5256.2020.08.036.
[11]	KRAJA B, MONE I, AKSHIJA I, et al. Predictors of esophageal varices and first variceal bleeding in liver cirrhosis patients[J]. World J Gastroenterol, 2017, 23(26): 4806-4814. DOI: 10.3748/wjg.v23.i26.4806.
[12]	HASSAN EM, OMRAN DA, EL BESHLAWEY ML, et al. Can transient elastography, Fib-4, Forns Index, and Lok Score predict esophageal varices in HCV-related cirrhotic patients?[J]. Gastroenterol Hepatol, 2014, 37(2): 58-65. DOI: 10.1016/j.gastrohep.2013.09.008.
[13]	KOTHARI HG, GUPTA SJ, GAIKWAD NR, et al. Role of non-invasive markers in prediction of esophageal varices and variceal bleeding in patients of alcoholic liver cirrhosis from central India[J]. Turk J Gastroenterol, 2019, 30(12): 1036-1043. DOI: 10.5152/tjg.2019.18334.
[14]	LIN PT, TENG W, JENG WJ, et al. The incidence and predictors of post transarterial chemoembolization variceal bleeding in hepatocellular carcinoma patients[J]. J Formos Med Assoc, 2020, 119(2): 635-643. DOI: 10.1016/j.jfma.2019.08.019.
[15]	CHAN AW, KUMADA T, TOYODA H, et al. Integration of albumin-bilirubin (ALBI) score into Barcelona Clinic Liver Cancer (BCLC) system for hepatocellular carcinoma[J]. J Gastroenterol Hepatol, 2016, 31(7): 1300-1306. DOI: 10.1111/jgh.13291.
[16]	HSIEH YC, LEE KC, WANG YW, et al. Correlation and prognostic accuracy between noninvasive liver fibrosismarkers and portal pressure in cirrhosis: Role of ALBI score[J]. PLoS One, 2018, 13(12): e0208903. DOI: 10.1371/journal.pone.0208903.
[17]	TOYODA H, LAI PB, O'BEIRNE J, et al. Long-term impact of liver function on curative therapy for hepatocellular carcinoma: Application of the ALBI grade[J]. Br J Cancer, 2016, 114(7): 744-750. DOI: 10.1038/bjc.2016.33.
[18]	ZOU D, QI X, ZHU C, et al. Albumin-bilirubin score for predicting the in-hospital mortality of acute upper gastrointestinal bleeding in liver cirrhosis: A retrospective study[J]. Turk J Gastroenterol, 2016, 27(2): 180-186. DOI: 10.5152/tjg.2016.15502.
[19]	XAVIER SA, VILAS-BOAS R, BOAL CARVALHO P, et al. Assessment of prognostic performance of Albumin-Bilirubin, Child-Pugh, and Model for End-stage Liver Disease scores in patients with liver cirrhosis complicated with acute upper gastrointestinal bleeding[J]. Eur J Gastroenterol Hepatol, 2018, 30(6): 652-658. DOI: 10.1097/MEG.0000000000001087.
[20]	FOUAD TR, ABDELSAMEEA E, ABDEL-RAZEK W, et al. Upper gastrointestinal bleeding in Egyptian patients with cirrhosis: Post-therapeutic outcome and prognostic indicators[J]. J Gastroenterol Hepatol, 2019, 34(9): 1604-1610. DOI: 10.1111/jgh.14659.

Relative Articles

[1]	Di WU, Dahua DAI, Wenmei LIANG, Bao FU, Xiaoyun FU. Clinical features of acute pancreatitis in pregnancy and related risk factors[J]. Journal of Clinical Hepatology, 2024, 40(5): 1009-1015. doi: 10.12449/JCH240522
[2]	Yufeng ZHENG, Xulei ZHANG, Yuhang WENG, Yongfeng YANG. Etiological spectrum and clinical features of patients with unexplained liver disease manifesting as isolated jaundice: An analysis of 91 cases[J]. Journal of Clinical Hepatology, 2023, 39(5): 1105-1109. doi: 10.3969/j.issn.1001-5256.2023.05.016
[3]	Chengsi ZHAO, Weijie YAO, Peng YUAN, Zuozheng WANG. Time distribution of risk factors for secondary pancreatic infection in acute pancreatitis[J]. Journal of Clinical Hepatology, 2022, 38(7): 1686-1690. doi: 10.3969/j.issn.1001-5256.2022.07.044
[4]	Ruihua ZHANG, Tingting QIN, Yueming SHAO, Yu ZHANG, Yang WANG, Xiaoyu WEN. Jaundice and portal hypertension caused by hepatic epithelioid hemangioendothelioma: A case report[J]. Journal of Clinical Hepatology, 2021, 37(7): 1662-1664. doi: 10.3969/j.issn.1001-5256.2021.07.036
[5]	Si XIE, Ming YANG, Yuan HUANG, Lai WEI. Differential diagnosis and treatment of jaundice after comprehensive treatment of advanced primary liver cancer: A case report[J]. Journal of Clinical Hepatology, 2021, 37(2): 400-402. doi: 10.3969/j.issn.1001-5256.2021.02.030
[6]	Wang CaiBin, Su Yang. Risk factors for posthepatectomy liver failure and related prevention and treatment methods[J]. Journal of Clinical Hepatology, 2020, 36(9): 2119-2124. doi: 10.3969/j.issn.1001-5256.2020.09.048
[7]	Cao Yuan, Yao GuoXiang, Shi YiHai. An excerpt of international consensus guidelines for risk factors in chronic pancreatitis (2020)[J]. Journal of Clinical Hepatology, 2020, 36(8): 1720-1722. doi: 10.3969/j.issn.1001-5256.2020.08.008
[8]	Lei Yu, Li JiaJia, Liu RongAn, Ceng Fan, Li GuiSen, Lan YunPing. Clinical features of patients with sepsis-induced cholestatic jaundice and risk factors for death[J]. Journal of Clinical Hepatology, 2020, 36(5): 1065-1071. doi: 10.3969/j.issn.1001-5256.2020.05.023
[9]	Yao ChengZi, Feng Gong, Yu WenSi, Du Huan, Mi Man. Risk factors for the development and progression of nonalcoholic fatty liver disease[J]. Journal of Clinical Hepatology, 2020, 36(2): 433-436. doi: 10.3969/j.issn.1001-5256.2020.02.044
[10]	Ren DanDan, Liu Na, Zhou LuLu, Zhang Nan, Li ChunXia, Dong Bing, Xu GuangHua. Risk factors for hepatitis B virus-related hepatocellular carcinoma[J]. Journal of Clinical Hepatology, 2020, 36(7): 1634-1638. doi: 10.3969/j.issn.1001-5256.2020.07.041
[11]	Luo XiaoKe, Li XiaoLing, Yang LiMing, Wang XiaoHong. Efficacy of magnesium isoglycyrrhizinate in treatment of hepatitis E with severe jaundice[J]. Journal of Clinical Hepatology, 2014, 30(6): 537-539. doi: 10.3969/j.issn.1001-5256.2014.06.014
[12]	Yu Zheng, Jia JiDong. Risk factors, diagnostic criteria, and drug discontinuation criteria for drug- induced liver injury[J]. Journal of Clinical Hepatology, 2013, 29(9): 674-677. doi: 10.3969/j.issn.1001-5256.2013.09.010
[13]	Bao XuLi, Tian Zhou, Chen QingFeng, Li Li, Zhang Lei, Lu: Jun. One case of primary hepatic amyloidosis characterized by jaundice[J]. Journal of Clinical Hepatology, 2013, 29(12): 943-944. doi: 10.3969/j.issn.1001-5256.2013.12.018
[14]	Wu XiaoQing, Wan Hong. Causes of liver failure and impact analysis of prognostic risk factors[J]. Journal of Clinical Hepatology, 2013, 29(4): 294-296+304.
[15]	Chen Qian, Wen XiaoYu, Pan Yu. Jaundice due to hepatic syphilis: A case report[J]. Journal of Clinical Hepatology, 2013, 29(4): 303-304.
[16]	Yang ZongGuo, Chen XiaoRong, Lu YunFei, Liu Cheng. Decotion in chronic hepatitis B patients (damp-heat blood stasis syndrome) with low-grade jaundice[J]. Journal of Clinical Hepatology, 2012, 28(10): 771-774+784.
[17]	Shi HaiDong. Clinical observation of alprostadil injection in the treatment of liver cirrhosis with jaundice[J]. Journal of Clinical Hepatology, 2011, 27(9): 962-964.
[18]	Dou WeiJia, Zhou Lin, Wu KaiChun. Risk factors of chronic pancreatitis[J]. Journal of Clinical Hepatology, 2011, 27(11): 1180-1183.
[19]	Wang Hong, Wang YingMin, Zhang Bo. Prospective analysis of risk factors for the occurrence of hepatocellular carcinoma in patients with post-hepatitis B cirrhosis[J]. Journal of Clinical Hepatology, 2007, 23(1): 34-35.
[20]	Wang Hong. Risk factors for patients with cirrhosis developed renal dysfunction[J]. Journal of Clinical Hepatology, 2004, 20(2): 101-102.

Supplements(0)

Cited By

Cited by

Periodical cited type(3)

1.	程玉鑫，刘亮，董适毓，李胜超，张萌. 外泌体蛋白、mRNA及非编码RNA调节肝癌发生和发展的研究进展. 实用医学杂志. 2024(06): 748-755 .
2.	王玲，曹信宇，商伟芳，丁秀婷. 慢性乙型肝炎患者外泌体miR-335-5p与肝硬化严重程度的相关性. 中国热带医学. 2024(03): 326-332 .
3.	窦金萍，高维崧，韦双，高新桃，李轶女. 外泌体MicroRNA在抗病毒免疫中的功能分析. 生物技术通报. 2024(05): 48-57 .

Other cited types(3)

Proportional views

Proportional views

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

Figures(1) / Tables(2)

Get Citation

PDF

XML

Article Metrics

Article views (936) PDF downloads(54)

Influencing factors of rebleeding after gastroscopy in patients with liver cirrhosis and esophagogastric variceal bleeding

DOI: 10.3969/j.issn.1001-5256.2021.09.018