Pfisterer Nikolaus, Riedl Florian, Schwarz Michael, Simbrunner Benedikt, Dominik Nina, Kramer Georg, Jachs Mathias, Hartl Lukas, Putre Florian, Ritt Lukas, Mandorfer Mattias, Holzmueller Philipp, Madl Christian, Trauner Michael, Reiberger Thomas
Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria; Klinik Landstrasse, 4th Medical Department of Gastroenterology and Hepatology, Vienna, Austria; University Hospital St. Pölten, St Pölten, Austria.
Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria; Sigmund Freud University, Private Medical School, Vienna, Austria.
Gastrointest Endosc. 2025 Nov;102(5):733-737. doi: 10.1016/j.gie.2025.04.045. Epub 2025 May 3.
Acute variceal bleeding (AVB), a severe adverse event of portal hypertension, may cause death in patients with cirrhosis. We investigated whether outcomes after AVB have improved over time.
Data from 406 patients with cirrhosis with AVB (2000-2022) from 2 Viennese centers were analyzed for recurrent bleeding, 6-week mortality, and 1-year transplant-free survival.
Recurrent bleeding rates within 6 weeks decreased from 19.4% to 11.8% (hazard ratio [HR], 0.59; 95% CI, 0.35-0.97; P = .049) and bleeding-related mortality decreased from 23.6% to 18.3% (HR, 0.68; 95% CI, 0.44-1.06; P = .099). One-year transplant-free survival after AVB improved from 63.8% to 73.7% (HR, 0.68; 95% CI, 0.47-0.97; P = .041). Higher Child-Pugh scores were associated with increased risk for bleeding (adjusted odds ratio [aOR], 1.68) and mortality (aOR, 1.69; both P < .001). Nonselective beta-blockers reduced 1-year mortality risk (aOR, 0.48; P = .038).
Recurrent bleeding and mortality rates after AVB improved over the last 2 decades but remain substantial, highlighting the need for continued efforts to optimize outcomes for patients with cirrhosis.
急性静脉曲张出血（AVB）是门静脉高压的一种严重不良事件，可导致肝硬化患者死亡。我们调查了AVB后的预后情况是否随时间有所改善。
对来自维也纳两个中心的406例肝硬化合并AVB患者（2000 - 2022年）的数据进行分析，以评估再出血情况、6周死亡率和1年无移植生存率。
6周内再出血率从19.4%降至11.8%（风险比[HR]，0.59；95%置信区间[CI]，0.35 - 0.97；P = 0.049），出血相关死亡率从23.6%降至18.3%（HR，0.68；95% CI，0.44 - 1.06；P = 0.099）。AVB后1年无移植生存率从63.8%提高到73.7%（HR，0.68；95% CI，0.47 - 0.97；P = 0.041）。较高的Child-Pugh评分与出血风险增加（调整优势比[aOR]，1.68）和死亡率增加（aOR，1.69；两者P < 0.001）相关。非选择性β受体阻滞剂降低了1年死亡风险（aOR，0.48；P = 0.038）。
在过去20年中，AVB后的再出血率和死亡率有所改善，但仍然很高，这凸显了继续努力优化肝硬化患者预后的必要性。
