Factors influencing prognosis for cirrhotic patients with esophagogastric variceal bleeding within 1 year after endoscopic variceal ligation

Abstract

Abstract: Objective To study factors influencing prognosis for cirrhotic patients with esophagogastric variceal bleeding within 1 year after endoscopic variceal ligation (EVL).Methods Three hundred and twenty-four cirrhotic patients with esophagogastric variceal bleeding receiving EVL from November 2017 to December 2018 were followed up for at least 1 year. Readmission for hemorrhage and death were regarded as poor prognosis. The multivariate logistic regression analysis was used to define factors influencing prognosis of patients, and a nomogram was developed to predict poor prognosis. Results All the patients were followed up for 12 to 25 months. Forty-six patients with poor prognosis were enrolled as observation group, the other 278 patients as control group. The incidence of poor prognosis was 14.2%. In observation group, there were 5, 10 and 31 patients classified as Child-Pugh grade A, B and C. In control group, there were 103, 120 and 55 patients classified as Child-Pugh grade A, B and C. The average diameter of varicose veins was (1.1±0.4) cm in observation group, and (0.8±0.5) cm in control group. There were significant differences in Child-Pugh grade and varicose vein diameter between the 2 groups (P<0.05). The hemoglobin of (78.6±10.0) g/L in observation group, was significantly lower than (85.4±8.9) g/L in control group (P<0.05). The total bilirubin (TBil) and γ-glutamyltranspeptidase were (42.8±4.9) μmol/L and (76.4±24.1) U/L in observation group, significantly higher than (27.3±5.2) μmol/L and (37.9±14.8) U/L in control group (P<0.05). The Child-Turcotte-Pugh (CTP) score, model for end-stage liver disease score and model for end-stage liver disease includes serum sodium (MELD-Na) score were (9.4±2.3), (10.8±2.2) and (11.2±2.5) in observation group, significantly higher than (7.8±3.1), (8.7±3.0) and (9.6±2.4) in control group (P<0.05). The multivariate logistic regression analysis showed that Child-Pugh grade [odds ratio (OR)=2.181, 95% confidence interval (CI): 1.475-3.225], TBil (OR=1.789, 95%CI: 1.241-2.579), CTP score (OR=2.518, 95%CI: 1.763-3.596) and MELD-Na score (OR=1.484, 95%CI: 1.084-2.032) were risk factors for poor prognosis in cirrhotic patients with esophagogastric variceal bleeding (P<0.05). The concordance index of nomogram to predict poor prognosis was 0.630.Conclusion The prognosis in cirrhotic patients with esophageal variceal bleeding within 1 year after EVL is related to liver function and MELD-Na score. The nomogram has high accuracy in predicting prognosis.

Key words: Esophagogastric variceal bleeding in cirrhosis, Endoscopic variceal ligation, Prognosis, Influencing factors

ZHANG Sheng-yan, HUANG Hong-chun, WANG Xiu-min. Factors influencing prognosis for cirrhotic patients with esophagogastric variceal bleeding within 1 year after endoscopic variceal ligation[J]. Chinese Hepatolgy, 2021, 26(2): 155-158.

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