Document Detail


Improved survival of patients presenting with acute variceal bleeding. Prognostic indicators of short- and long-term mortality.
MedLine Citation:
PMID:  17005458     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIM: Variceal bleeding is a severe complication of portal hypertension with a mortality rate between 30% and 60% in previous studies. During the last two decades the treatment of these patients has been improved. The aim of this study was to investigate the clinical outcome of patients after an episode of acute variceal bleeding and to identify risk factors for early and late mortality in these patients. MATERIALS AND METHODS: All patients with acute variceal bleeding hospitalised at two large hospitals between January 1, 1999 and June 30, 2004, were retrospectively enrolled in this study. After discharge, patients were followed until death or study closure date, on June 30, 2005. Bleeding related mortality, 6-week, 1-year and overall mortality were evaluated as well as factors related to early and late mortality. RESULTS: One hundred and forty one patients were included (114 men, 27 women) with a mean age of 60.5+/-13.5 years. In hospital, 6-week, 1-year and overall mortality were 12.1%, 18.4%, 32.6% and 48.2%, respectively. The mean length of hospitalisation was 11.4+/-9 days (1-55) and the mean packed red blood cell requirement was 3.9+/-3.7 (0-25). The rate of recurrent bleeding was 10.7% during initial hospitalisation. Being Child-Pugh C (p=0.003) and shock on admission (p=0.037) were independent predictors of 6-week mortality, while being Child-Pugh C (p=0.028), presence of hepatocellular carcinoma or other neoplasia (p=0.04) and partial thromboplastin time (p=0.021) during the initial admission were independent predictors for 1-year mortality. Mortality was not affected by the presence of active bleeding and/or white nipple at emergency endoscopy. Also presence of infection was not an adverse factor of clinical outcome in our patients. CONCLUSIONS: In conclusion, the clinical outcome of patients with acute variceal bleeding is better in comparison with previous studies. The severity of liver failure as well as the presence of neoplasia mainly affects the survival.
Authors:
K Thomopoulos; G Theocharis; K Mimidis; Ch Lampropoulou-Karatza; E Alexandridis; V Nikolopoulou
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study     Date:  2006-09-26
Journal Detail:
Title:  Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver     Volume:  38     ISSN:  1590-8658     ISO Abbreviation:  Dig Liver Dis     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2006-11-22     Completed Date:  2007-04-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100958385     Medline TA:  Dig Liver Dis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  899-904     Citation Subset:  IM    
Affiliation:
Division of Gastroenterology, University Hospital of Patras, Greece.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Biological Markers / analysis
Esophageal and Gastric Varices / diagnosis,  mortality*
Female
Gastrointestinal Hemorrhage / diagnosis,  mortality*
Humans
Male
Middle Aged
Prognosis
Retrospective Studies
Survival Analysis
Time Factors
Chemical
Reg. No./Substance:
0/Biological Markers

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