Analysis Of Factors Influencing Variceal Rebleeding In Cirrhosis

Objectives A case-control study to analyze the factors influencing the occurrence of early and late rebleeding after the first bleeding control in patients with cirrhotic varices.Methods Patients with cirrhotic variceal bleeding(including esophageal and gastric variceal bleeding)who met the requirements and were hospitalized at Beijing Ditan Hospital from January Gregorian calendar 2008 to January Gregorian calendar 2017 were selected,and relevant observations were collected including baseline information(age,gender,etiology,family history,past history,personal history),laboratory results(routine blood,liver function,kidney function,electrolytes,lipids,blood glucose,coagulation function),Child-Pugh classification,degree of esophagogastric varices,diameter of portal vein,spleen thickness,complications of cirrhosis,and treatment modality after the first bleeding.Patients with rebleeding within 2 years of the follow-up period were used as the case group,among which patients with early rebleeding(rebleeding within 72h～6w after the first bleeding)were case group 1(early rebleeding group);patients with late rebleeding(rebleeding>6w after the first bleeding,within the 2-year follow-up period)were case group 2(late rebleeding group);patients without rebleeding during the follow-up period were used as the control group.In the univariate analysis,the measures meeting the normal distribution were expressed as“mean±standard deviation”and the non-normal distribution was expressed as“median(interquartile range)”.The t-test was used to compare the means of two samples,and the nonparametric rank sum test was used to compare the medians of two groups;the Mann-Whitney U test was used to compare between groups for rank data;theχ~2 test was used to compare between groups for composition of count data.In the multifactorial analysis,the variables that were statistically significant in the univariate analysis were subjected to multifactorial logistic regression analysis to screen the influencing factors of variceal rebleeding in cirrhosis.Results 1148 cases were listed,409 cases within the non-rebleeding cluster,188 cases within the early rebleeding cluster and 551 cases in the delayed rebleeding group.The univariate analyses of history of diabetes,Child-Pugh class,degree of esophagogastric varices,splenic thickness,diameter of portal vein(DPV),hemoglobin(Hb),platelet(PLT),serum sodium(Na~+),alanine aminotransferase(ALT),aspartate aminotransferase(AST),cholinesterase(CHE),total cholesterol(TC),and activated partial thrombin time(APTT)between the non-rebleeding group and the early rebleeding group were statistically significant.The univariate analyses of history of diabetes,degree of esophagogastric varices,diameter of portal vein,spleen thickness,Hb,WBC were statistically significant in the group without rebleeding and in the group with delayed rebleeding,and the multi-factor logistic regression results indicate that Hb,Na~+,APTT,Child-Pugh classification,degree of esophagogastric varices were associated with early rebleeding in cirrhosis.Hb,history of diabetes,spleen thickness,and degree of esophagogastric varices are associated with delayed rebleeding in cirrhosis.Conclusions 1 Hb,Na~+,APTT,Child-Pugh classification,and degree of esophagogastric varices are influential factors for early rebleeding in cirrhotic esophagogastric varices;reduced Hb,reduced Na~+,prolonged APTT,high Child-Pugh classification,and severe esophagogastric varices may increase the risk of early rebleeding.2 Hb,history of diabetes mellitus,spleen thickness,and degree of esophagogastric varices are factors influencing the late rebleeding of esophagogastric varices in Liver Cirrhosis;decreased Hb,history of diabetes mellitus,increased splenic thickness,and severe degree of esophagogastric varices may increase the risk of late rebleeding.Figure0;Table24;Reference 155...