Analysis Of Related Factors And Risk Assessment Of Re-hemorrhage In Patients With Cirrhosis Complicated With Esophagogastic Variceal Bleeding

Objective(s):(1)To comprehensively analyze the factors related to nosocomial re-hemorrhage in patients with cirrhosis complicated with esophagogastic variceal bleeding.(2)Independent related factors were used to establish a risk prediction formula for the hospital re-bleeding.(3)To evaluated the clinical predictive value of the risk prediction formula for re-hemorrhage.Methods:114 cases of cirrhosis with esophagogastic variceal bleeding diagnosed and treated in the gastroenterology department of the seconed affiliated hospital of Kunming medical university from January 2015 to June 2018 were included as study objects.40 cases with nosocomial re-bleeding were set as the study group(nosocomial re-bleeding group),and those without nosocomial re-bleeding were set as the control group(good prognosis group).The basic characteristic,hemodynamics,laboratory examination,imaging indexes,endoscopy indexes and other related indexs of the two groups were statistically analyzed.Logistic regression analysis was used to screen out the independent affecting factors of the patients' nosocomial rebleeding.the risk prediction formula of nosocomial re-bleeding was established and the predictive value of the risk formula was evaluated.Results:(1)To compare the basic characteristics,laboratory indexes,imaging and endoscopy indicators between the experimental group and the control group,the univariate analysis showed that there were statistically significant differences in albumin,red sign under endoscopy,portal vein width,and blood loss between the two groups(P<0.05).(2)Binary logistic regression analysis showed that the albumin is an independent protective factor(P:0.017,OR:0.906)and the portal vein width is an independent risk factor of early hospital re-bleeding(P:0.002,OR:6.447).(3)Logistic regression analysis was used to establish the risk prediction formula:P=ez/1+ez(-3.352-0.099×albumin+1.864×portal vein width+0.038×diastolic pressure).The area under the curve of risk model AUC was 0.755(0.655,0.846),and the specificity and sensitivity were 60.8%and 85.0%respectively.Conclusion(s):(1)Serum albumin,red sign under endoscopy,portal vein width and blood loss are of certain reference value for the prediction of hospital re-bleeding in patients with liver cirrhosis complicated by esophagogastric variceal bleeding.(2)The portal vein width is an independent risk factor and the serum albumin is an independent protective factor for early hospital re-bleeding in patients with liver cirrhosis complicated by esophagogastric variceal bleeding.(3)The probabilistic risk prediction formula of early nosocomial re-bleeding established based on independent influencing factors has certain accuracy and sensitivity,and low specificity.