Independent Factors Associated with Recurrent Bleeding in Cirrhotic Patients with Esophageal Variceal Hemorrhage

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Independent Factors Associated with Recurrent Bleeding in Cirrhotic Patients

with Esophageal Variceal Hemorrhage

Journal Digestive Diseases and Sciences

Publisher Springer Netherlands

ISSN 0163-2116 (Print) 1573-2568 (Online)

Category Original Article

DOI 10.1007/s10620-008-0454-0

Subject Collection Medicine

SpringerLink Date Wednesday, December 03, 2008

Shou-Wu Lee1 , Teng-Yu Lee1, 2 and Chi-Sen Chang1, 2

(1) Department of Internal Medicine, Division of Gastroenterology, Taichung

Veterans General Hospital, 160, Section 3, Taichung Harbor Road, Taichung, 407,

Taiwan

(2) Department of Medicine, Chung Shan Medical University, Taichung, Taiwan

Received: 11 June 2008 Accepted: 16 July 2008 Published online: 3 December

2008

Abstract Background, Purpose, and Methods Cirrhotic patients with acute

esophageal variceal (EV) hemorrhage are characterized by high mortality and

rebleeding rates. This study was conducted to investigate the independent

indicators of recurrent hemorrhage in cirrhotic patients within 6 weeks after

cessation of initial EV bleeding. Ninety-seven consecutive cirrhotic patients

with EV bleeding, but without evidence of infection, who were admitted to our

hospital between December 2005 and February 2008 were retrospectively analyzed.

Among these patients, 14 patients with recurrent hemorrhage and 83 without

rebleeding within 6 weeks were enrolled as the rebleeding group and

non-rebleeding group, respectively. Results The incidence of infection and

number of EV ligations were significantly higher in the rebleeding group than in

the non-rebleeding group (P = 0.043 and 0.042, respectively). Other parameters,

such as age, gender, etiology and severity of liver cirrhosis, ascites, spleen

diameter, laboratory data, hepatocellular carcinoma, portal vein thrombosis,

peptic ulcer disease, blood pressure, requirements of blood transfusion and

differential vasoactive mediations, had no significant influence on the

incidence of rebleeding. The ratio of mortality (7/14 vs. 3/83) was

significantly higher in the rebleeding group (P = 0.0002), and these cases were

caused by rebleeding and sepsis. The frequency of rebleeding and mortality

mostly occurred within the first 2 weeks after admission. Conclusion This study

provides evidence that early recurrent hemorrhage after initial EV bleeding in

cirrhotic patients is significantly associated with higher incidence of

bacterial infection and more numbers of EV ligations due to extensive surface

area of mucosal injury and post-banding ulcers. Prevention of rebleeding and

infection plays a major role in reducing the rate of mortality in cirrhotic

patients with EV bleeding.

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Shou-Wu Lee

Email: ericest@...