Risk Factors Of Esophageal And Gastric Varices Bleeding In Patients With Liver Cirrhosis

Objective:The clinical features of esophageal and gastric variceal bleeding (EGVB) are massive hematemesis, hematochezia, rapid hypotension, or hemorrhagic shock. EGVB is the most primary cause of death in cirrhosis, therefore, how to effectively prevent bleeding is very important. This research was to further investigate risk factors of EGVB in patients with liver cirrhosis by retrospective analysis of general information, laboratory tests, and results of abdominal ultrasound and gastroscopy.Methods:1.192hospitalized patients with cirrhosis who occurred EGVB in the Frist Affiliated Hospital of Dalian Medical University during July2002to February2012were selected as the EGVB group.158sex-and-age matched hospitalized cirrhotic patients with esophageal and gastric varices but no hemorrhage and survived in the corresponding time period were selected as the control group.2. Data such as age, gender, etiology, the time of onset, platelet count (PLT), serum total bilirubin (TB), serum albumin (ALB), activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin activity (TT), diameters of the spleen and portal vein, thickness of the spleen, ascites, degree of esophageal varices, red color sign, portal hypertensive gastropathy (PHG) and peptic ulcer were analysed. First, all the variables were examined by univariate analysis. Then those with statistical significance were examined with multivariate analysis using Logistic regression procedures, to verify the major risk factors of EGVB with cirrhosis.Results:1. Esophageal and gastric varices bleeding in patients with liver cirrhosis occurred frequently in spring and winter (66.7%)(a period of Nov to Apr), while rarely happened in other seasons.2. Compared with non-bleeding group, PLT, PT, ALB, ascites diameter of the portal vein, diameters of splenic vein, degree of esophageal varices and red color sign of the hemorrhage group were demonstrated statistical significance (all P<0.05). 3. Multivariate Logistic regression analysis showed that compared with non-bleeding group, PT, diameter of the portal vein, red color sign, degree of esophageal varices in hemorrhage group correlated positively with the occurrence of patients accompanying with EGVB, while PLT did negative correlation with it (P<0.05). The regression coefficients were0.221,0.322,0.304,1.037and-0.273, respectively. Relative risks (OR) were1.248,1.380,1.356,2.821and0.314, respectively.Conclusion:1. In Dalian area, esophageal and gastric varices bleeding occurred in patients with cirrhosis existing seasonality.2. PLT, PT, red color sign, increased diameter of the portal vein and degree of esophageal varices were independent risk factors to induce esophageal and gastric varices bleeding in patients with liver cirrhosis, and red color sign was the most important risk factor. To monitor PLT and PT promptly may be important for prevention of EGVB.