Influencing factors of rebleeding after gastroscopy in patients with liver cirrhosis and esophagogastric variceal bleeding
10.3969/j.issn.1001-5256.2021.09.018
- VernacularTitle:肝硬化食管胃静脉曲张出血患者胃镜治疗术后再出血的影响因素分析
- Author:
Jia LIAN
1
,
2
,
3
;
Tao HAN
1
,
2
,
3
;
Huiling XIANG
1
,
2
,
3
;
Yankai YANG
1
,
2
,
3
;
Tinghong LI
1
,
2
,
3
;
Lei LIU
1
,
2
,
3
;
Baiguo XU
1
,
2
,
3
;
Lixia SUN
1
,
2
,
3
;
Fei WANG
1
,
2
,
3
;
Yanchao FU
1
,
2
,
3
Author Information
1. Department of Hepatology, Tianjin Third Central Hospital
2. The Third Central Clinical College of Tianjin Medical University
3. Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China
- Publication Type:Original articles_Liver fibrosis and liver cirrhosis
- Keywords:
Liver Cirrhosis;
Esophageal and Gastric Varices;
Gastroscopy;
Hemorrhage;
Root Cause Analysis
- From:
Journal of Clinical Hepatology
2021;37(9):2092-2096
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the influencing factors for rebleeding after gastroscopy in patients with liver cirrhosis and esophagogastric variceal bleeding. Methods A retrospective analysis was performed for the clinical data of the patients with liver cirrhosis and esophagogastric variceal bleeding who were hospitalized in Tianjin Third Central Hospital from January 1, 2017 to December 31, 2018, and according to the presence or absence of rebleeding and bleeding time, the patients were divided into non-bleeding group ( n =148) and bleeding group ( n =119). The risk factors for rebleeding after gastroscopy were analyzed. The t -test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The Cox regression model was used for univariate and multivariate analyses. The receiver operating characteristic (ROC) curve was used to evaluate the accuracy of Child-Turcotte-Pugh (CTP), fibrosis-4 (FIB-4), and albumin-bilirubin (ALBI) scores in predicting rebleeding after gastroscopy, and MedCalc was used to compare the area under the ROC curve (AUC). Results A total of 267 patients with liver cirrhosis and esophagogastric variceal bleeding were enrolled, among whom 53 (19.9%) had liver cancer. A total of 119 patients suffered from rebleeding, with an overall rebleeding rate of 44.6% and a median time to rebleeding of 11.0 (0-39.0) months. The univariate Cox regression analysis showed that liver cancer (hazard ratio [ HR ]=0.377, P < 0.001), aspartate aminotransferase (AST) ( HR =1.002, P =0.025), serum Na ( HR =0.935, P =0.004), and FIB-4 ( HR =1.030, P =0.049) were associated with rebleeding, and the multivariate Cox regression analysis showed that liver cancer ( HR =0.357, P < 0.001), AST ( HR =1.003, P =0.030), prothrombin time (PT) ( HR =0.196, P =0.001), CTP score ( HR =1.289, P =0.014), FIB-4 ( HR =1.062, P =0.033), and ALBI score ( HR =0.433, P =0.011) were independent risk factors for rebleeding. CTP, FIB-4, and ALBI scores had an AUC of 0.711 (95% confidence interval [ CI ]: 0.647-0.776), 0.705 (95% CI : 0.640-0.770), and 0.730 (95% CI : 0.667-0.793), respectively, in predicting rebleeding. There was no significant difference in AUC between CTP, FIB-4, and ALBI scores ( P > 0.05). Conclusion Liver cancer, AST, PT, CTP score, FIB-4 score, and ALBI score are associated with rebleeding after gastroscopy in patients with liver cirrhosis and esophagogastric variceal bleeding, among which CTP, FIB-4, and ALBI scores have a good value in predicting rebleeding outcome, while there is no significant difference in predictive ability between them.
