Multivariate Analysis Of The Affecting Factors For The Effect Of Endoscopic Treatment On Esophageal Varices In Cirrhosis

Objective: By comparing the general condition,laboratory test,imaging examination,endoscopic character,endoscopic treatment and the timing of treatment of the(re)bleeding group and the non-bleeding group after the first endoscopic treatment of patients with cirrhosis and esophageal varices,screening out the relevant factors affecting the efficacy of endoscopic treatment of cirrhotic esophageal varices,and more hoping to screen out relevant independent risk factors and provide reference for clinical.The risk assessment before endoscopic treatment can be performed according to the clinical indicators of the patient,and other interventions can be performed on the high-risk patients,thereby reducing the incidence of(re)bleeding after treatment and improving the survival rate of the patient.Methods: Retrospective analysis of patient's information admitted to the Second Hospital of Dalian Medical University from January 2006 to December 2016 with complete case data and follow-up results,which diagnosis as decompensated cirrhosis and esophageal varices combined with endoscopic treatment.Including general conditions(sex,age,etiology of cirrhosis,ascites,hepatic encephalopathy and longterm regular use of non-selective beta blockers),laboratory tests(AST,ALT,GGT,ALP,TBIL,DBIL,ALB,PLT,Urea,Cr,PT,INR,TC),imaging examinations(portal vein width,spleen size),endoscopic characters(Grade classification,varices diameter,numbers,red color sign,erosion or thrombosis,active bleeding,peptic ulcer and portal hypertensive gastropathy),endoscopic treatments(EVL,EIS and combination therapy)and the timing of treatments(primary prophylaxis,the treatment of acute variceal hemorrhage,secondary prophylaxis).Statistical analysis was performed by SPSS23.0 software,and statistical analysis was performed using statistical methods such as Chisquare test,Fisher exact test,independent sample T test,Mann-Whitney U rank sum test and multivariate logistic regression analysis.Results: A total of 113 patients were enrolled in the decompensated cirrhosis and esophageal varices combined with first endoscopic treatment.Among them,52 patients in the bleeding group and 61 patients in the non-bleeding group during the follow-up period.There were no significant differences between the two groups in general conditions(sex,age,etiology of cirrhosis,ascites,hepatic encephalopathy and longterm regular use of non-selective beta blockers),laboratory tests(AST,ALT,GGT,ALP,TBIL,DBIL,ALB,PLT,Urea,Cr,PT,INR,TC),imaging examinations(portal vein width,spleen size),endoscopic characters(Grade classification,varices diameter,numbers,red color sign,erosion or thrombosis,active bleeding,peptic ulcer and portal hypertensive gastropathy),endoscopic treatments and the timing of treatments(P>0.05).However,the standardized follow-up treatment(P = 0.000)and the number of treatments(P = 0.000)were associated with the occurrence of re-bleeding after the first endoscopic treatment.We consider that other relevant factors are meaningless because too much influence of standardized follow-up treatment on the occurrence of(re)bleeding.Our study further analyzed the effects of relevant factors in the standardized follow-up treatment group on(re)bleeding.The results showed that there was a correlation between long-term regular use of non-selective beta blockers(P = 0.016),ALB(P = 0.030),PLT(P = 0.043),PT(P = 0.020),the timing of treatment(P = 0.010)and the occurrence of(re)bleeding after endoscopic treatment.The indicators of the statistical significance of univariate analysis to join multivariate logistic regression analysis,ALB was an independent protective factor(B=-0.170,OR=0.844,P=0.033),and the timing of treatment was an independent risk factor,among them,the treatment of acute variceal hemorrhage was statistically significant in terms of(re)bleeding compared with primary prophylaxis,while secondary prevention was not statistically significant in terms of(re)bleeding relative to primary prophylaxis(the treatment of acute variceal hemorrhage: B = 3.656,OR = 38.693,P = 0.007;secondary prophylaxis: B = 2.172,OR = 8.778,P = 0.057).Conclusion: The standardized follow-up treatment is the influencing factor of whether(re)bleeding occurs after cirrhosis combined with esophageal varices for the first endoscopic treatment.For patients with standardized follow-up treatment,long-term regular use of non-selective beta blockers,ALB,PLT,PT,and the timing of treatment have a correlation between recurrent(re)bleeding after first endoscopic treatment with cirrhosis and esophageal varices,in which ALB was an independent protective factor and the treatment timing was an independent risk factor,wherein the treatment of acute variceal hemorrhage has an increased risk of postoperative(re)bleeding compared with primary prophylaxis,while secondary prophylaxis has no difference in(re)bleeding compared with primary prophylaxis.