Early rebleeding increases mortality of variecal bleeders on secondary prophylaxis with β-blockers and ligation
| Autor: | Marta Garcia-Guix, Laura Gonzalez, Mar Concepción, Virginia Hernández-Gea, Alan Colomo, Carles Aracil, Oana Pavel, Edilmar Alvarado-Tapias, Berta Cuyas, Xavier Torras, Isabel Graupera, Anna Brujats, Maria Poca, Càndid Villanueva, Alba Ardevol |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Liver Cirrhosis Male medicine.medical_specialty Variceal bleeding Time Factors Cirrhosis Adrenergic beta-Antagonists Esophageal and Gastric Varices Severity of Illness Index Gastroenterology Recurrence Internal medicine Secondary Prevention medicine Humans In patient Prospective Studies Ligation Aged Hepatology business.industry Secondary prophylaxis Middle Aged medicine.disease Combined Modality Therapy Survival Analysis Treatment Outcome Spain Hepatic Encephalopathy Portal hypertension Female Risk of death Portasystemic Shunt Transjugular Intrahepatic Gastrointestinal Hemorrhage business |
| Zdroj: | Digestive and Liver Disease. 52:1017-1025 |
| ISSN: | 1590-8658 |
| DOI: | 10.1016/j.dld.2020.06.005 |
| Popis: | Despite secondary-prophylaxis with β-blockers and endoscopic-variceal-ligation rebleeding is frequent, particularly within the first-6-weeks. Early-rebleeding may have greater impact on death-risk than late rebleeding, which may affect therapy. We assessed whether the influence of rebleeding on long-term survival of patients on secondary-prophylaxis is greater in patients with early-rebleeding.369 patients with cirrhosis were consecutively included once recovered from first variceal-bleeding. The impact of rebleeding on survival was investigated according to whether it occurred within 6-weeks (early-rebleeding) or later (late-rebleeding).During 46-months of follow-up (IQR: 14-61), 45 patients (12%) had early-rebleeding, 74(20%) had late-rebleeding and 250(68%) had not rebleeding. Mortality risk was higher in early-rebleeding group vs. late-rebleeding (HR = 0.476, 95%CI = 0.318-0.712, p 0.001) and was similar in late-rebleeding group vs. no-rebleeding (HR = 0.902, 95%CI = 0.749-1.086, p = 0.271). Adjusting for baseline risk-factors, early-rebleeding was independently associated with mortality-risk (HR = 1.58, 95%CI = 1.02-2.45; p = 0.04). Child-PughMELD scores improved at 3rd-4th-week only in patients without early-rebleeding (p 0.05). Presence of ascites or encephalopathy, MELD-score12 and HVPG20 mmHg identified patients at risk of early-rebleeding.Patients with early-rebleeding have higher risk of death than patients without rebleeding and even than those rebleeding later. Our results suggest that patients at risk of early rebleeding might benefit from preemptive therapies such as early-TIPS. |
| Databáze: | OpenAIRE |
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