Department of Emergency, Changhai Hospital, Second Military Medical School, Shanghai 200433, China.
Chin Med J (Engl). 2011 May;124(10):1493-7.
Esophageal variceal bleeding is a frequent and severe complication in patients with cirrhosis. The aim of this study was to identify prognostic factors of esophageal variceal rebleeding in cirrhotic inpatients.
Consecutive cirrhotic patients who were admitted to Changhai Hospital because of esophageal variceal bleeding were retrospectively analyzed. To assess the independent factors for recurrent hemorrhage after esophageal variceal bleeding, medical assessment was completed at the time of their initial hospital admission, including documentation of clinical, biochemical, and treatment methods that might contribute to variceal rebleeding. Univariate and multivariate analyses were retrospectively performed.
Totally 186 patients (35.8%) were assigned to a rebleeding group and the other 334 patients (64.2%) to a non-rebleeding group. Multivariate stepwise regression analysis showed that four variables were positively correlated with rebleeding: Child-pugh grade B (OR = 2.664, 95%CI 1.680 - 4.223) (compared with Child-pugh grade A), total bilirubin (Tbil) (OR = 1.0006, 95%CI 1.002 - 1.0107), creatinine (OR = 1.008, 95%CI 1.002 - 1.015) and the cumulative volume of blood transfusion (OR = 1.519, 95%CI 1.345 - 1.716). The presence of ascites (OR = 0.270, 95%CI 0.136 - 0.536) and prophylactic antibiotics (OR = 0.504, 95%CI 0.325 - 0.780) were negatively correlated with rebleeding of the cirrhotic inpatients. According to standardized coefficient, the importance of rebleeding predictors ranked from the most to the least was as follows: the cumulative volume of blood transfusion, Child-pugh grade B, Tbil and creatinine.
Rebleeding in cirrhotic inpatients was associated with more blood transfusions, Child-pugh grade B, higher Tbil and creatinine.
食管胃静脉曲张出血是肝硬化患者常见且严重的并发症。本研究旨在确定肝硬化住院患者食管静脉曲张再出血的预后因素。
回顾性分析因食管胃静脉曲张出血而入住长海医院的连续肝硬化患者。为了评估食管胃静脉曲张出血后再出血的独立因素，在患者初次入院时进行了医学评估，包括记录可能导致静脉曲张再出血的临床、生化和治疗方法。进行了单因素和多因素分析。
共有 186 名患者（35.8%）被分配到再出血组，334 名患者（64.2%）被分配到非再出血组。多因素逐步回归分析显示，有四个变量与再出血呈正相关：Child-pugh 分级 B（OR=2.664，95%CI 1.680-4.223）（与 Child-pugh 分级 A 相比），总胆红素（Tbil）（OR=1.0006，95%CI 1.002-1.0107），肌酐（OR=1.008，95%CI 1.002-1.015）和累计输血量（OR=1.519，95%CI 1.345-1.716）。腹水的存在（OR=0.270，95%CI 0.136-0.536）和预防性使用抗生素（OR=0.504，95%CI 0.325-0.780）与肝硬化患者的再出血呈负相关。根据标准化系数，再出血预测因子的重要性从大到小依次为：累计输血量、Child-pugh 分级 B、Tbil 和肌酐。
肝硬化患者再出血与输血量增加、Child-pugh 分级 B、Tbil 和肌酐升高有关。
