Department of Gastroenterology, Hospital de Sant Pau, Barcelona, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
Hepatology. 2018 Apr;67(4):1458-1471. doi: 10.1002/hep.29370. Epub 2018 Feb 18.
The presence of cirrhosis increases the mortality of patients with peptic ulcer bleeding (PUB). Both acute variceal bleeding (AVB) and PUB are associated with substantial mortality in cirrhosis. This multicenter cohort study was performed to assess whether the mortality of patients with cirrhosis with PUB is different from that of those with AVB. Patients with cirrhosis and acute gastrointestinal bleeding were consecutively included and treated with somatostatin and proton pump inhibitor infusion from admission and with antibiotic prophylaxis. Emergency endoscopy with endoscopic therapy was performed within the first 6 hours. 646 patients with AVB and 144 with PUB were included. There were baseline differences between groups, such as use of gastroerosive drugs or β-blockers. Child-Pugh and Model for End-Stage Liver Disease MELD scores were similar. Further bleeding was more frequent in the AVB group than those in the PUB group (18% vs. 10%; odds ratio [OR] = 0.50; 95% confidence interval [CI] = 0.29-0.88). However, mortality risk at 45 days was similar in both groups (19% in the AVB group vs. 17% in the PUB group; OR = 0.85; 95% CI = 0.55-1.33; P = 0.48). Different parameters, such as Child-Pugh score, acute kidney injury, acute on chronic liver failure, or presence of shock or bacterial infection, but not the cause of bleeding, were related to the risk of death. Only 2% of the PUB group versus 3% of the AVB group died with uncontrolled bleeding (P = 0.39), whereas the majority of patients in either group died from liver failure or attributed to other comorbidities.
Using current first-line therapy, patients with cirrhosis and acute peptic ulcer bleeding have a similar survival than those with variceal bleeding. The risk of further bleeding is higher in patients with variceal hemorrhage. However, few patients in both groups died from uncontrolled bleeding, rather the cause of death was usually related to liver failure or comorbidities. (Hepatology 2018;67:1458-1471).
评估肝硬化患者发生消化性溃疡出血（PUB）与急性静脉曲张出血（AVB）的死亡率是否存在差异。
这是一项多中心队列研究，纳入了连续收治的肝硬化合并急性胃肠道出血患者，入院后给予生长抑素和质子泵抑制剂输注，并进行抗生素预防。发病 6 小时内行急诊内镜检查并进行内镜治疗。
共纳入 646 例 AVB 患者和 144 例 PUB 患者。两组间存在基线差异，如胃侵蚀性药物或β受体阻滞剂的使用。Child-Pugh 评分和终末期肝病模型 MELD 评分相似。进一步出血在 AVB 组比 PUB 组更常见（18%比 10%；比值比 [OR] = 0.50；95%可信区间 [CI] = 0.29-0.88）。然而，两组 45 天死亡率相似（AVB 组 19%，PUB 组 17%；OR = 0.85；95%CI = 0.55-1.33；P = 0.48）。不同的参数，如 Child-Pugh 评分、急性肾损伤、急性慢加急性肝衰竭、休克或细菌感染的存在，但不是出血的原因，与死亡风险相关。仅 2%的 PUB 组患者因未控制的出血而死亡，而 AVB 组的这一比例为 3%（P = 0.39），但两组大多数患者的死亡原因是肝功能衰竭或归因于其他合并症。
使用目前的一线治疗，肝硬化合并急性消化性溃疡出血患者的生存率与静脉曲张出血患者相似。静脉曲张出血患者进一步出血的风险更高。然而，两组中只有少数患者因未控制的出血而死亡，死亡原因通常与肝功能衰竭或合并症有关。
