The Effectiveness of Current Acute Variceal Bleed Treatments in Unselected Cirrhotic Patients: Refining Short-Term Prognosis and Risk Factors

Subject Category: Liver

Am J Gastroenterol advance online publication 25 September 2012; doi: 10.1038/ajg.2012.313

Lucio Amitrano MD¹, Maria Anna Guardascione MD¹, Francesco Manguso MD¹, Raffaele Bennato MD¹, Antonio Bove MD¹, Claudio DeNucci MD¹, Giovanni Lombardi MD¹, Rossana Martino MD¹, Antonella Menchise MD¹, Luigi Orsini MD¹, Salvatore Picascia MD¹ and Elisabetta Riccio MD¹

¹Gastroenterology Unit, AORN A. Cardarelli, Naples, Italy

Correspondence: Lucio Amitrano, Gastroenterology Unit, AORN A. Cardarelli, Via Morghen 92, Napoli 80129, Italy. E-mail: luamitra@tin.it

Received 29 January 2012; Accepted 10 August 2012
Advance online publication 25 September 2012

Abstract

OBJECTIVES:

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.

METHODS:

One hundred and eighty five patients with liver cirrhosis and variceal bleeding admitted from January 2010 to July 2011were evaluated.

RESULTS:

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 10×10⁹/l, and the presence of PVT were the only independent predictors of the 5-day failure.

CONCLUSIONS:

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.

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