Prediction of Large Esophageal Variceal Bleeding and Subsequent Mortality

• Published in: Hepato-gastroenterology Vol. 61; no. 131; p. 678
• Main Authors: Soga, Koichi, Kassai, Kyoichi, Konishi, Hideyuki, Yagi, Nobuaki, Itani, Kenji, Kokura, Satoshi, Naito, Yuji, Yoshikawa, Toshikazu
• Format: Journal Article
• Language: English
• Published: Greece 01.05.2014
• Subjects: Biomarkers - blood; Chi-Square Distribution; Esophageal and Gastric Varices - blood; Esophageal and Gastric Varices - diagnosis; Esophageal and Gastric Varices - mortality; Esophageal and Gastric Varices - therapy; Esophageal and Gastric Varices - virology; Gastrointestinal Hemorrhage - blood; Gastrointestinal Hemorrhage - diagnosis; Gastrointestinal Hemorrhage - mortality; Gastrointestinal Hemorrhage - therapy; Gastrointestinal Hemorrhage - virology; Humans; Hypertension, Portal - blood; Hypertension, Portal - diagnosis; Hypertension, Portal - mortality; Hypertension, Portal - therapy; Hypertension, Portal - virology; Kaplan-Meier Estimate; Liver Cirrhosis - blood; Liver Cirrhosis - diagnosis; Liver Cirrhosis - mortality; Liver Cirrhosis - therapy; Liver Cirrhosis - virology; Logistic Models; Multivariate Analysis; Odds Ratio; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Serologic Tests; Serum Albumin - analysis; Serum Albumin, Human; Severity of Illness Index
• ISSN: 0172-6390
• DOI: 10.5754/hge11521

Ruptured esophageal varices (EV) are commonly associated with bleeding in patients with portal hypertension. As previous studies have been designed to include all viral cirrhosis patients, including those with small varices, there are no definitive reports of the risk factors for large EV (LEV) bleeding and subsequent mortality. In this study we sought to investigate these risk factors. 16 patients with initial episodes of LEV bleeding and 56 patients who had undergone initial preventive treatment for LEV were examined. The Child-Pugh score, MELD score, and their component serological factors were examined. The Child-Pugh score and the MELD score were significantly lower for preventive cases. Serum albumin concentration was significantly lower in bleeding cases, as determined by univariable and multivariable analyses. In initial LEV bleeding cases, higher MELD scores and Child-Pugh scores, and lower serum albumin concentration were associated with significantly higher one-year mortality. These results indicate that control of the MELD score, the Child-Pugh score, and serum albumin concentration is key to improving the prognosis of patients with LEV. Especially, control of serum albumin concentration may be critical for the prevention of initial episodes of LEV bleeding and improving subsequent mortality.