Abstract: Objective To identify the factors influencing recompensation in patients with hepatitis B virus (HBV)-related cirrhosis presenting with esophageal-gastric variceal bleeding (EGVB) as their first de-compensation event. Methods A total of 107 HBV-related cirrhotic patients with EGVB as initial de-compensation event who were treated in the Affiliated Hospital of Xuzhou Medical University from January 2018 to December 2023 were enrolled in this study. The patients were categorized into a re-compensation group (n=44) and a persistent de-compensation group (n=63) according to the criteria for re-compensation from Chinese Society of Hepatology at 2022. Demographic, laboratory, imaging, and treatment data were collected from all patients. Intergroup comparisons were performed using Mann-Whitney U test、χ² or Fisher′s exact test. The independent factors influencing recompensation were identified by binary logistic regression analysis, and the performance of predictive value was evaluated using the area under the receiver operating characteristic curve (AUC) method. Results Among 107 patients with esophageal-gastric variceal bleeding, re-compensation was observed in 44 cases (41.1%). In the re-compensation group, age, serum potassium, serum chloride, and the proportion of diabetes mellitus were recorded as (46.1±9.2) years, 3.93 mmol/L, 104.85 mmol/L, and 4.55%, respectively, which were all lower than those of [(52.3±11.9) years, 4.03 mmol/L, 105.90 mmol/L, and 19.05%] in the persistent de-compensation group. A higher rate of splenectomy combined with pericardial de-vascularization (SPD) was found in the re-compensation group compared to the persistent de-compensation group (40.91% vs. 9.52%), with statistically significant differences (t/χ²=2.91, -2.04, -1.97, 4.79, 14.67, all P<0.05). By Logistic regression analysis it was revealed that increased age, elevated total bilirubin levels, and SPD treatment were identified as independent influencing factors for recompensation (95% CI: 0.90~0.99, 0.90~0.99, 1.95~16.52; OR=0.94, 0.94, 5.68, all P<0.05). ROC analysis showed that the AUC values for age, SPD treatment history, and total bilirubin were 0.64, 0.65, and 0.56, respectively, with sensitivities of 0.46, 0.90, and 0.68, and specificities of 0.30, 0.41, and 0.05. The combined predictive model achieved an AUC of 0.79, with a sensitivity of 0.73 and a specificity of 0.70. Conclusion HBV-related cirrhotic patients with EGVB who are older or have elevated total bilirubin are less likely to achieve re-compensation, while those undergoing SPD are more likely to attain re-compensation.

Key words: Hepatitis B virus, Liver cirrhosis, Esophagogastric variceal bleeding, Risk factors