October 2, 2012

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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