Thomopoulos K, Theocharis G, Mimidis K, Lampropoulou-Karatza Ch, Alexandridis E, Nikolopoulou V
Division of Gastroenterology, University Hospital of Patras, Greece.
Dig Liver Dis. 2006 Dec;38(12):899-904. doi: 10.1016/j.dld.2006.08.002. Epub 2006 Sep 26.
Variceal bleeding is a severe complication of portal hypertension with a mortality rate between 30% and 60% in previous studies. During the last two decades the treatment of these patients has been improved. The aim of this study was to investigate the clinical outcome of patients after an episode of acute variceal bleeding and to identify risk factors for early and late mortality in these patients.
All patients with acute variceal bleeding hospitalised at two large hospitals between January 1, 1999 and June 30, 2004, were retrospectively enrolled in this study. After discharge, patients were followed until death or study closure date, on June 30, 2005. Bleeding related mortality, 6-week, 1-year and overall mortality were evaluated as well as factors related to early and late mortality.
One hundred and forty one patients were included (114 men, 27 women) with a mean age of 60.5+/-13.5 years. In hospital, 6-week, 1-year and overall mortality were 12.1%, 18.4%, 32.6% and 48.2%, respectively. The mean length of hospitalisation was 11.4+/-9 days (1-55) and the mean packed red blood cell requirement was 3.9+/-3.7 (0-25). The rate of recurrent bleeding was 10.7% during initial hospitalisation. Being Child-Pugh C (p=0.003) and shock on admission (p=0.037) were independent predictors of 6-week mortality, while being Child-Pugh C (p=0.028), presence of hepatocellular carcinoma or other neoplasia (p=0.04) and partial thromboplastin time (p=0.021) during the initial admission were independent predictors for 1-year mortality. Mortality was not affected by the presence of active bleeding and/or white nipple at emergency endoscopy. Also presence of infection was not an adverse factor of clinical outcome in our patients.
In conclusion, the clinical outcome of patients with acute variceal bleeding is better in comparison with previous studies. The severity of liver failure as well as the presence of neoplasia mainly affects the survival.
静脉曲张出血是门静脉高压的一种严重并发症，以往研究中的死亡率在30%至60%之间。在过去二十年中，这些患者的治疗方法已有改进。本研究的目的是调查急性静脉曲张出血发作后患者的临床结局，并确定这些患者早期和晚期死亡的危险因素。
回顾性纳入1999年1月1日至2004年6月30日期间在两家大型医院住院的所有急性静脉曲张出血患者。出院后，对患者进行随访，直至死亡或2005年6月30日研究结束日期。评估了出血相关死亡率、6周、1年和总死亡率以及与早期和晚期死亡相关的因素。
纳入141例患者（114例男性，27例女性），平均年龄为60.5±13.5岁。住院期间、6周、1年和总死亡率分别为12.1%、18.4%、32.6%和48.2%。平均住院时间为11.4±9天（1 - 55天），平均浓缩红细胞需求量为3.9±3.7（0 - 25）。初次住院期间再出血率为10.7%。Child-Pugh C级（p = 0.003）和入院时休克（p = 0.037）是6周死亡率的独立预测因素，而初次入院时Child-Pugh C级（p = 0.028）、肝细胞癌或其他肿瘤的存在（p = 0.04）以及部分凝血活酶时间（p = 0.021）是1年死亡率的独立预测因素。死亡率不受急诊内镜检查时活动性出血和/或白色乳头的影响。感染的存在在我们的患者中也不是临床结局的不利因素。
总之，与以往研究相比，急性静脉曲张出血患者的临床结局较好。肝衰竭的严重程度以及肿瘤的存在主要影响生存率。
