ABSTRACT
Introdução: Varizes esofágicas estão presentes em aproximadamente 50% dos pacientes cirróticos e são responsáveis por até 30% de todos os casos de hemorragia digestiva alta. Apesar de sua mortalidade estar decaindo nas últimas décadas, decorrente da implementação de drogas vasoativas e terapêuticas endoscópicas, ainda mantém-se em níveis elevados. Objetivo: Avaliar mortalidade e os fatores prognósticos associados à hemorragia digestiva alta varicosa nos pacientes com cirrose hepática internados num hospital público de Santa Catarina. Métodos: Estudo observacional e retrospectivo, sendo a amostra composta por 125 casos de pacientes com cirrose hepática admitidos por hemorragia digestiva alta varicosa no período de janeiro de 2008 a janeiro de 2013 no Hospital Hans Dieter Schmidt Joinville/SC. Resultados: O sexo masculino e a etiologia alcoólica foram responsáveis pela maioria dos casos. Somente 30% dos pacientes faziam uso de profilaxia com betabloqueador. A maioria dos pacientes apresentava disfunção hepática grave (Child-Pugh B e C). As varizes de grosso calibre corresponderam a 65% das endoscopias e em 55% apresentavam sangramento ativo. A taxa de mortalidade foi de 41%. Conclusão: A etiologia alcoólica, sinais de choque, sangramento ativo durante a endoscopia, grau de disfunção hepática, assim como a má aderência ao tratamento profilático, estiveram associados à maior mortalidade. A alta taxa de mortalidade observada neste estudo nos estimula ao planejamento de estratégias de detecção e correção precoce de fatores prognósticos modificáveis.
Introduction: Esophageal varices are present in about 50% of cirrhotic patients and are responsible for 30% of all cases of upper gastrointestinal bleeding. Despite the rate of deaths are falling in recent decades, due to the implementation of vasoactive drugs and therapeutic endoscopic, still remains at high levels. Objective: To evaluate mortality and prognostic factors associated with variceal upper gastrointestinal bleeding in cirrhotic patients hospitalized in a public hospital in Santa Catarina. Methods: An observational, retrospective study, with the sample of 125 medical records of patients with liver cirrhosis admitted for variceal upper gastrointestinal bleeding from January 2008 to January 2013 in the Hans Dieter Schmidt Hospital - Joinville. Results: The male gender and alcoholic etiology were responsible for most cases. Only 30% of patients were taking beta-blocker prophylaxis. Most patients had severe hepatic impairment (Child-Pugh B and C). The large varices accounted for 65% of endoscopies and 55% had active bleeding. The mortality rate was 41%. Conclusion: The alcoholic etiology, signs of shock, active bleeding during endoscopy, liver dysfunction degree as well as poor adherence to prophylactic treatment were associated with higher mortality. The high mortality rate observed in this study encourages us to design detection strategies and early correction of modifiable prognostic factors.
ABSTRACT
Objective To analyze the prognostic factors in treating variceal hemorrhage patients of liver cirrhosis and portal hypertension with transjugular intrahepatic portosystemic shunt (TIPS).Methods From January 2003 to December 2008, the data of 162 variceal hemorrhage patients with liver cirrhosis and portal hypertension treated with TIPS was collected, which included basic information, biochemical examination results within 7 days before the operation, regular follow-up observation after the surgery and survival data. The survival prognostic indexes were assessed with Cox regression model. Results The successful rate of TIPS was 99% (161/162). The median follow up duration was 21 months. Child-Pugh score and blood platelet count (PLT) were closely correlated with survival (P = 0. 003 and 0. 024). The total cumulative survival rate in patients with Child-Pugh score below nine (75%, 102/136) was higher than over nine (50%, 13/26) (χ2 = 9. 12,P=0. 003).The total cumulative survival rate of patients with PLT count over 47 ×109/L (74%, 82/112) was higher than below 47 × 109/L(66 %, 33/50, χ2 =4. 528, P = 0. 033). The one year after operation cumulative survival rate of liver function Child-Pugh class A, B, and C was 92%, 85%, 55% respectively. Conclusion Child-Pugh score and platelet count are independent predictable factors for the survival of variceal hemorrhage patients with liver cirrhosis and portal hypertension treated by TIPS. The risk increase after operation when Child-Pugh score over 9 and/or PLT count less 47×109 /L.