Majid Shahid, Azam Zahid, Shah Hasnain Ali, Salih Mohammad, Hamid Saeed, Abid Shahab, Jafri Wasim
Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan.
Indian J Gastroenterol. 2009 May-Jun;28(3):93-5. doi: 10.1007/s12664-009-0034-z. Epub 2009 Nov 12.
Variceal bleed is a severe complication of portal hypertension. We studied the predictors of failure to control variceal bleed and re-bleed in patients with cirrhosis. We reviewed the case records of 382 consecutive patients admitted with variceal bleed from January 2001 to December 2005. Diagnosis of cirrhosis was made on clinical, laboratory, and radiological parameters. Acute variceal bleeding, failure to control bleed, and re-bleeding were defined according to Baveno III consensus report. Failure to control bleed was observed in 39 (10.2%) patients while in hospital re-bleed occurred in 49 (12.8%) patients. Thirty-four patients died. Diabetes was present in 148 (39%) patients. On multivariate logistic regression analysis, predictors of failure to control bleed were presence of diabetes mellitus and active bleeding at the time of endoscopy; predictors of in-hospital re-bleed were diabetes mellitus and serum bilirubin >3 mg/dL. Diabetes mellitus, active bleeding at endoscopy and bilirubin >3 mg/dL are bad prognostic factors for initial control of variceal bleed, and recurrent bleed in patients with cirrhosis.
静脉曲张破裂出血是门静脉高压的一种严重并发症。我们研究了肝硬化患者静脉曲张破裂出血控制失败和再出血的预测因素。我们回顾了2001年1月至2005年12月期间连续收治的382例静脉曲张破裂出血患者的病例记录。根据临床、实验室和影像学参数做出肝硬化诊断。急性静脉曲张出血、出血控制失败和再出血根据巴韦诺III共识报告进行定义。39例（10.2%）患者出现出血控制失败，49例（12.8%）患者在住院期间发生再出血。34例患者死亡。148例（39%）患者患有糖尿病。多因素逻辑回归分析显示，出血控制失败的预测因素为糖尿病和内镜检查时活动性出血；住院期间再出血的预测因素为糖尿病和血清胆红素>3mg/dL。糖尿病、内镜检查时活动性出血以及胆红素>3mg/dL是肝硬化患者静脉曲张破裂出血初始控制和再出血的不良预后因素。
