Risk factors of rebleeding in cirrhotic patients with esophageal gastric variceal bleeding after endoscopic treatment

Abstract

Abstract: Objective To investigate the risk factors for rebleeding within 180 days after endoscopic treatment in cirrhotic patients with esophageal gastric variceal bleeding (EGVB), and to compare the risk factors with child-Turcotte-Pugh (CTP) score, model for end-stage liver disease (MELD), MELD-Na, and integrated MELD (iMELD) and cirrhosis acute gastrointestinal bleeding (CAGIB). Methods A total of 142 cirrhotic patients with EGVB in our hospital from November 1, 2019 to November 31, 2021 were retrospective included, they were divided into rebleeding group and no bleeding group. The baseline data differences between the 2 groups were compared by t-test and non-parameter test. Univariate and multifactor Cox proportional risk regression was used to determine independent predictors of rebleeding. The performance of the Cox multifactor predictive model and CTP, MELD-Na, and CAGIB on the probability of rebleeding at 180 days was evaluated by the receiver operating characteristic (ROC). The area under the receiver operating characteristic (AUROC) was compared among prediction models through the DeLong method. Results During the 180-day follow-up period, rebleeding occurred in 61 (43.0%) patients, and 81 (57.0%) patients without rebleeding. Cox univariate regression analysis showed that the etiology (HR=1.970, 95%CI: 1.155~3.362, P<0.013), portal vein thrombosis (HR=2.605, 95%CI: 1.102~3.869, P=0.024), ApoA1 (HR=2.009, 95%CI: 1.196~3.374, P=0.008), fibrinogen (HR=2.683, 95%CI: 1.558~4.621, P<0.001) were associated with rebleeding; Cox multivariate regression analysis showed that the etiology (HR=3.922, 95%CI: 1.843~8.346, P<0.001), portal vein thrombosis (HR=2.798, 95%CI: 1.385~5.652, P=0.004), ApoA1 (HR=2.207, 95%CI: 1.122~4.340, P=0.022), fibrinogen (HR=2.729, 95%CI: 1.405~5.300, P=0.003) were independently associated with rebleeding within 180 days. ROC curve analysis showed that the predictive value of Cox multivariate hybrid models (AUROC 0.773, P<0.001) was better than MELD (AUROC 0.602, P=0.0388), iMELD (AUROC 0.620, P=0.0145), MELD-Na (AUROC 0.618, P=0.0166), CTP score (AUROC 0.688, P<0.001) and CAGIB (AUROC 0.625, P=0.0108).Conclusion The performance of combined model composed of etiology of cirrhosis, portal vein thrombosis, ApoA1 and fibrinogen had better predictive value for rebleeding in cirrhotic patients with EVGB after endoscopic treatment.

Key words: Liver Cirrhosis, Esophageal gastric variceal bleeding, Rebleeding, Risk factors

HE Qing-lian, YU Bao-ping, XIAO Yong. Risk factors of rebleeding in cirrhotic patients with esophageal gastric variceal bleeding after endoscopic treatment[J]. Chinese Hepatolgy, 2023, 28(1): 55-60.

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