Campo R, Brullet E, Montserrat A, Calvet X, Dalmau B, Gil M, Güell J, Mas P
Unidad de Endoscopia Digestiva (S.D.I), CH Parc Taulí, Sabadell, Barcelona.
Rev Esp Enferm Dig. 1996 Jun;88(6):395-9.
To assess the prognostic factors of early mortality in cirrhotic patients with the first variceal bleeding episode.
Fifty-five cirrhotic patients with endoscopic evidence of variceal bleeding treated with sclerotherapy during emergent endoscopy were included.
Permanent hemostasis was obtained in 36 patients (65.5%). Fourteen (25.4%) patients died within six weeks of the bleeding episode. Twenty-four variables obtained at admission and in the following days were compared between patients who survived (n = 41), and died (n = 14). In the univariate analysis the following variables were related to early mortality: prothrombin ratio (p = 0.04), the presence of ascites (p = 0.004) and encephalopathy (p = 0.06), albumin (p = 0.01), Child-Pugh score (p = 0.0003), hemostasis during endoscopy (p = 0.002), absence of rebleeding at 24 hours (p = 0.01) and early rebleeding (within five days after the bleeding episode) (p = 0.006). Multiple logistic regression identified the Child-Pugh score (OR 11.86, CI 95% 2.54-55.48; p = 0.001) and early rebleeding (OR 6.27, CI 95% 1.29-30.44; p = 0.02) as prognostic independent factors of early mortality.
The degree of hepatic failure and early rebleeding are prognostic independent factors of early mortality in cirrhotic patients after the first variceal bleeding episode.
评估首次发生静脉曲张出血的肝硬化患者早期死亡的预后因素。
纳入55例在急诊内镜检查时接受硬化治疗且有静脉曲张出血内镜证据的肝硬化患者。
36例患者（65.5%）实现了永久性止血。14例（25.4%）患者在出血事件发生后的六周内死亡。对存活患者（n = 41）和死亡患者（n = 14）入院时及随后几天获得的24个变量进行了比较。单因素分析中，以下变量与早期死亡相关：凝血酶原比值（p = 0.04）、腹水的存在（p = 0.004）和肝性脑病（p = 0.06）、白蛋白（p = 0.01）、Child-Pugh评分（p = 0.0003）、内镜检查时的止血情况（p = 0.002）、24小时内无再出血（p = 0.01）以及早期再出血（出血事件发生后五天内）（p = 0.006）。多因素逻辑回归分析确定Child-Pugh评分（OR 11.86，95%CI 2.54 - 55.48；p = 0.001）和早期再出血（OR 6.27，95%CI 1.29 - 30.44；p = 0.02）为早期死亡的独立预后因素。
肝衰竭程度和早期再出血是首次静脉曲张出血事件后肝硬化患者早期死亡的独立预后因素。
