Prognostic factors associated with rebleeding in cirrhotic inpatients complicated with esophageal variceal bleeding

摘要

＜正＞ Background Esophageal variceal bleeding is a frequent and severe complication in patients with cirrhosis. The aim ofthis study was to identify prognostic factors of esophageal variceal rebleeding in cirrhotic inpatients.Methods Consecutive cirrhotic patients who were admitted to Changhai Hospital because of esophageal varicealbleeding were retrospectively analyzed. To assess the independent factors for recurrent hemorrhage after esophagealvariceal bleeding, medical assessment was completed at the time of their initial hospital admission, includingdocumentation of clinical, biochemical, and treatment methods that might contribute to variceal rebleeding. Univariateand multivariate analyses were retrospectively performed.Results Totally 186 patients （35.8%） were assigned to a rebleeding group and the other 334 patients （64.2%） to anon-rebleeding group. Multivariate stepwise regression analysis showed that four variables were positively correlatedwith rebleeding: Child-pugh grade B （OR=2.664, 95% CI 1.680-4.223） （compared with Child-pugh grade A）, total bilirubin（Tbil） （OR=1.0006, 95% CI 1.002-1.0107）, creatinine （OR=1.008, 95% CI 1.002-1.015） and the cumulative volume ofblood transfusion （OR=1.519, 95% CI 1.345-1.716）. The presence of ascites （OR=0.270, 95% CI 0.136-0.536） andprophylactic antibiotics （OR=0.504, 95% CI 0.325-0.780） were negatively correlated with rebleeding of the cirrhoticinpatients. According to standardized coefficient, the importance of rebleeding predictors ranked from the most to theleast was as follows: the cumulative volume of blood transfusion, Child-pugh grade B, Tbil and creatinine.Conclusion Rebleeding in cirrhotic inpatients was associated with more blood transfusions, Child-pugh grade B, higherTbil and creatinine.