Gastroenterology Unit, AORN A. Cardarelli, Naples, Italy.
Am J Gastroenterol. 2012 Dec;107(12):1872-8. doi: 10.1038/ajg.2012.313. Epub 2012 Sep 25.
The mortality from esophageal variceal hemorrhage in liver cirrhosis patients remains approximately 15-20%. Predictors of short-term outcomes, such as the hepatic venous pressure gradient, are often unavailable in the acute setting. Clinical variables seem to have a similar predictive performance, but some variables including active bleeding during endoscopy have not been reevaluated after the utilization of endoscopic banding as endoscopic procedure. In addition, patients with severe liver failure are often excluded from clinical trials. The aim of this study was to prospectively reevaluate the risk factors affecting a 5-day failure after acute variceal bleeding in unselected cirrhotic patients, managed with the current standard treatment using vasoactive drugs, band ligation, and antibiotics.
One hundred and eighty five patients with liver cirrhosis and variceal bleeding admitted from January 2010 to July 2011 were evaluated.
Hepatocellular carcinoma was present in 28.1% of cases and portal vein thrombosis (PVT) was present in 17.3% of cases. Band ligation was feasible in 92.4% of cases. Five-day failure occurred in 16.8% of cases; 12 patients (6.5%) experienced failure to control bleeding or early rebleeding, and 66.7% of patients died within 5 days. The overall 5-day mortality rate was 14.6%. By multivariate analysis, we determined that Child-Pugh class C, a white blood cell count over 10 × 10(9)/l, and the presence of PVT were the only independent predictors of the 5-day failure.
The prognosis of a consistent group of liver cirrhosis patients with variceal bleeding remains poor. The current treatment is highly effective in controlling variceal bleeding, but mortality is related mainly to the severity of liver failure.
肝硬化患者食管静脉曲张出血的死亡率仍约为 15-20%。肝静脉压力梯度等短期预后预测因子在急性情况下通常无法获得。临床变量似乎具有相似的预测性能，但一些变量，包括内镜下活动性出血，在使用内镜套扎作为内镜程序后尚未重新评估。此外，严重肝功能衰竭的患者通常被排除在临床试验之外。本研究旨在前瞻性地重新评估在未选择的肝硬化患者中，使用当前标准治疗方案（血管活性药物、套扎和抗生素）治疗急性静脉曲张出血后 5 天内失败的影响因素。
评估了 2010 年 1 月至 2011 年 7 月期间入院的 185 例肝硬化合并静脉曲张出血患者。
肝细胞癌占 28.1%，门静脉血栓形成（PVT）占 17.3%。92.4%的患者可行套扎治疗。5 天内失败的发生率为 16.8%；12 例（6.5%）发生出血控制失败或早期再出血，5 天内死亡 66.7%。总的 5 天死亡率为 14.6%。多变量分析表明，Child-Pugh 分级 C、白细胞计数超过 10×10(9)/l 和 PVT 的存在是 5 天失败的唯一独立预测因子。
一组连续的肝硬化静脉曲张出血患者的预后仍然很差。目前的治疗方案在控制静脉曲张出血方面非常有效，但死亡率主要与肝功能衰竭的严重程度有关。
