Risk factors for early rebleeding after endoscopic therapy for esophageal varices in cirrhotic patients / 临床肝胆病杂志

ABSTRACT

Objective To investigate the risk factors for early rebleeding after endoscopic ligation or sclerotherapy for esophageal variceal bleeding in cirrhotic patients. Methods A retrospective analysis was performed for the clinical data of 153 cirrhotic patients with esophageal variceal bleeding who underwent endoscopic ligation or sclerotherapy in Beijing YouAn Hospital, Capital Medical University, from May 2017 to May 2019, and according to the presence or absence of rebleeding from 72 hours to 6 weeks after endoscopic therapy, the patients were divided into rebleeding group and non-rebleeding group. A logistic regression analysis was performed to investigate independent risk factors for early rebleeding. The t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups. Results Early rebleeding rate was 24.8% (38/153). Compared with the non-rebleeding group, the rebleeding group had a significantly lower albumin (Alb) and significantly higher activated partial thromboplastin time and prothrombin time (all P < 0.05), and there were also significant differences between the two groups in proportion of male sex, degree of varicose veins, red color sign, portal vein thrombosis, severity of ascites, and liver function grade (all P < 0.05). The multivariate logistic regression analysis showed that portal vein thrombosis (odds ratio [ OR ]=9.781, 95% confidence interval [ CI ] 2.248-42.556, P =0.002), massive ascites ( OR =6.195, 95% CI 1.053-36.447, P =0.044), and Child-Pugh class C liver function ( OR =6.434, 95% CI 1.067-38.786, P =0.042) were independent risk factors for early rebleeding, while Alb ( OR =0.806, 95% CI 0.685-0.947, P =0.009) was a protective factor against early rebleeding. Conclusion Portal vein thrombosis, massive ascites, Child-Pugh C liver cirrhosis, and hypoproteinemia are independent risk factors for early rebleeding after endoscopic therapy in cirrhotic patients with esophageal variceal bleeding, which should be taken seriously in clinical practice.