Risk Factors Of Esophageal Varices Bleeding In Cirrhotic Patients:A Meta-analysis

Objective:Based on the original research,this study conducted a systematic analysis to find risk factors related to esophagogastric variceal bleeding in liver cirrhosis,and to screen,early diagnose,promptly treat,Prevention provides a solid basis.Methods:We searched the PubMed,EMBASE,web of Science(ISI),the Cochrane Library(CENTRAL),China biomedical database(CBM),CNKI,VIP and Wanfang databases for the literature on the risk factors for cirrhosis with esophageal variceal bleeding from the beginning of the database establishment to October 2019.Endnote-X9 was used to for document management,review manager 5.3 software was used to for meta analysis.Newcastle Ottawa scale was used to evaluate the quality of the literature.Results:Eventually included in the literature 63,of which 53 were cross-sectional studies and 10 were cohort studies.A total of 14360 patients were included in cirrhosis,of which 6665 were bleeding from esophageal varices,with a bleeding rate of 46.41%.The meta-analysis results show that the following indicators have statistical differences compared with the non-bleeding group in the cirrhotic EGVB group : gender(female)[OR=0.88,95%CI;(0.81,0.96)],hemoglobin[SMD=-1.04;95% CI;(-1.62,-0.47)],platelet count[SMD=-0.68,95%CI;(-0.93,0.440)],PT[SMD=0.84,95%CI;(0.64,1.04)],PTA% [SMD=0.36;95% CI;(-0.51,-0.02)];ALB[SMD=0.48,CI;(-0.66,-0.29)],serum [SMD=-0.32;95%CI;(-0.62,-0.03)],Red sign[OR=5.89,95%CI;(3.55,9.78)],Severe esophageal varices [OR=4.90,95%CI;(3.05,7.88)],Child-Pugh Grade(Grade C)[OR=1.58,95%CI;(1.12,2.25)],Internal portal vein diameter [SMD=0.93,95%CI;(0.75,1.12)],Internal diameter of splenic vein [SMD=0.75,95%CI;(0.62,0.87)],Left gastric vein diameter[SMD=2.08,95%CI;(1.30,2.87)],portal vein blood flow velocity [SMD=-0.77,95%CI;(-1.06,-0.48)],Left gastric vein blood flow velocity [SMD=1.44,95%CI;(0.96,1.91)];Long diameter of spleen[SMD=0.50,95%CI;(0.07,0.92)],ascites[OR=1.35,95%CI;(1.02,1.79)].There was no significant difference in sex(male),age,etiology,leukocyte count,serum creatinine,total bilirubin,ALT,AST,APTT,INR,urea nitrogen,serum potassium,spleen thickness,splenic vein blood flow velocity,hepatic encephalopathy between patients with and without EGVB.For higher heterogeneity factors,the indicators,such as age,platelet count,prothrombin time,prothrombin activity,etc.The results of sensitivity analysis in the above-mentioned included literatures were relatively stable after one-by-one elimination method.However,the included literatures in this study were not presented due to the large number of graphs generated by this method.Conclusion:1.Low platelet count,PT prolongation,PTA% decrease,hypoproteinemia,low serum sodium,red color sign,severe esophageal varices,Child-Pugh grade(grade C),widening of portal vein diameter,widening of splenic vein diameter,widening of left gastric vein diameter,slowing of portal vein blood flow rate and ascites were all risk factors of EGVB in patients with cirrhosis.2.Age,etiology of cirrhosis,leukocyte count,serum creatinine,total bilirubin,ALT,AST,APTT,INR,urea nitrogen,blood potassium,spleen thickness,splenic vein blood flow velocity,hepatic encephalopathy were not risk factors for EGVB in patients with cirrhosis.3.Gender(female)is a protective factor for EGVB in patients with liver cirrhosis,whether hemoglobin is a risk factor for EGVB in patients with cirrhosis needs to be further included in more prospective studies.