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©2011 Baishideng Publishing Group Co.
World J Gastroenterol. Apr 28, 2011; 17(16): 2120-2125
Published online Apr 28, 2011. doi: 10.3748/wjg.v17.i16.2120
Published online Apr 28, 2011. doi: 10.3748/wjg.v17.i16.2120
Table 1 Characteristics of patients with rebleeding after endoscopic variceal band ligation for esophageal varices bleeding (mean ± SD) n (%)
Variable | Overall (n = 128) |
Sex (male/female) | 107 (83.6)/21 (16.4) |
Age (yr) | 53.6 ± 13.9 |
Etiology | |
Virus | 61 (47.7) |
Alcohol | 31 (24.2) |
Virus + alcohol | 28 (21.9) |
Others | 8 (6.2) |
Index EGD finding | |
Active EV bleeding | 39 (30.5) |
Blood in lumen | 49 (38.3) |
Clean | 40 (31.2) |
Duration between rebleeding and Index EVL | 14.0 (10.8) |
1-5 d | 33 (25.8) |
6-42 d | 95 (74.2) |
Index EVL | |
CTP score | 9.8 ± 2.3 |
CTP classification | |
A | 12 (9.40) |
B | 44 (34.4) |
C | 72 (56.2) |
MELD | 19.8 ± 8.9 |
Rebleeding | |
CTP score | 10.1 ± 2.6 |
CTP classification | |
A | 14 (10.9) |
B | 36 (28.1) |
C | 78 (60.9) |
MELD | 21.4 ± 9.8 |
Table 2 Rebleeding focus, therapy and outcome of patients with rebleeding after endoscopic variceal band ligation for esophageal varices bleeding n (%)
Overall (n = 128) | |
Rebleeding focus | |
EV bleeding | 75 (58.6) |
Post-EVL ulcer bleeding | 24 (18.8) |
GV bleeding | 7 (5.5) |
Peptic ulcer bleeding | 11 (8.6) |
PHG | 11 (8.6) |
Therapy for rebleeding | |
Endoscopic and pharmacologic therapy | 92 (71.9) |
Pharmacologic therapy only | 35 (27.3) |
Surgery | 1 (0.8) |
Rebleeding 5-d failure | 24 (18.8) |
Uncontrolled bleeding and died within 5 d | 8 (6.3) |
Died of non-bleeding cause | 2 (1.6) |
Recurrent bleeding within 5 d | 14 (10.9) |
5-d mortality | 10 (7.8) |
6-wk mortality | 49 (38.3) |
6-wk mortality causes | |
Sepsis-induced multi-organ failure | 26 (53.1) |
GI bleeding | 18 (36.7) |
Liver failure | 5 (10.2) |
3-mo mortality | 71 (55.5) |
6-mo mortality | 75 (58.6) |
Table 3 Variables associated with 6-wk mortality in patients with rebleeding after endoscopic variceal band ligation for esophageal varices bleeding (mean ± SD) n (%)
Variable | 6-wk mortality (n = 49, 38.3%) | 6-wk survival (n = 79, 61.7%) | P-value |
Sex (male/female) | 40 (81.6)/9 (18.8) | 67 (84.8)/12 (17.6) | 0.637 |
Age (yr) | 53.3 ± 13.3 | 53.7 ± 14.3 | 0.866 |
Etiology | 0.683 | ||
Virus | 23 (46.9) | 38 (48.1) | |
Alcohol | 11 (22.4) | 20 (25.3) | |
Virus + alcohol | 13 (26.5) | 15 (19.0) | |
Others | 2 (4.1) | 6 (7.6) | |
HCC | 0.291 | ||
No or small | 29 (59.2) | 54 (68.4) | |
Advanced | 20 (40.8) | 25 (31.6) | |
PVT | 0.786 | ||
Main trunk | 12 (24.5) | 18 (22.8) | |
Branch | 5 (10.2) | 9 (11.4) | |
Duration between rebleeding and index EVL | 12.8 ± 9.0 | 14.7 ± 11.7 | 0.528 |
1-5 d | 13 (26.5) | 20 (25.3) | 0.879 |
6-42 d | 36 (73.5) | 59 (74.7) | |
Rebleeding laboratory findings | |||
CTP score | 11.9 ± 1.9 | 8.9 ± 2.3 | 0.000 |
CTP classification | |||
A | 1 (2.0) | 13 (16.5) | 0.017 |
B | 3 (6.1) | 33 (41.8) | 0.000 |
C | 45 (91.8) | 33 (41.8) | 0.000 |
MELD score | 28.9 ± 9.0 | 16.8 ± 7.0 | 0.000 |
HE (grade) | 1.3 ± 1.5 | 0.3 ± 0.8 | 0.000 |
Cr (μmol/L) | 203.3 ± 159.1 | 114.9 ± 97.2 | 0.000 |
Na (mmol/L) | 138.7 ± 9.6 | 134.6 ± 14.3 | 0.084 |
K (mmol/L) | 4.2 ± 1.0 | 3.9 ± 0.9 | 0.171 |
Bil (μmol/L) | 263.3 ± 236.0 | 90.6 ± 135.1 | 0.000 |
Alb (g/L) | 25 ± 5 | 29 ± 6 | 0.000 |
Hb (g/L) | 83 ± 18 | 90 ± 17 | 0.041 |
WBC (109/L) | 12.5 ± 6.4 | 8.2 ± 4.7 | 0.000 |
Platelets (109/L) | 102.4 ± 69.2 | 101.0 ± 72.3 | 0.915 |
INR (PT) | 2.2 ± 0.9 | 1.5 (0.4) | 0.000 |
Rebleeding 5-d failure | 18 (36.7) | 6 (7.6) | 0.000 |
Died within 5 d | 10 | 0 | 0.000 |
Recurrent bleeding within 5 d | 8 | 6 | 0.150 |
Hypovolemic shock | 21 (42.9) | 3 (3.8) | 0.000 |
Rebleeding focus | 0.500 | ||
EV bleeding | 28 (57.1) | 47 (59.5) | |
Post-EVL ulcer bleeding | 9 (18.4) | 15 (19.0) | |
GV bleeding | 3 (6.1) | 4 (5.1) | |
Peptic ulcer bleeding | 6 (12.2) | 5 (6.3) | |
PHG | 3 (6.1) | 8 (10.1) | |
Rebleeding EGD finding | 0.019 | ||
Active bleeding | 20 (40.8) | 30 (38.0) | |
Blood in lumen | 25 (51.0) | 27 (34.2) | |
Clean | 4 (8.2) | 22 (27.8) | |
EGD Tx | 0716 | ||
Endoscopic therapy + medical | 36 (73.5) | 56 (70.9) | |
Medical therapy only | 13 (26.5) | 22 (27.8) | |
Surgery | 0 (0.0) | 1 (1.3) | |
Rebleeding infection | 42 (85.7) | 36 (45.6) | 0.000 |
Rebleeding antibiotic use | 35 (71.4) | 46 (58.2) | 0.132 |
Rebleeding Inderal use | 8 (16.3) | 37 (46.8) | 0.000 |
Table 4 Logistic regression models for variables associated with 6-wk mortality in patients with rebleeding after endoscopic variceal band ligation for esophageal varices bleeding
Variables | UV | MV | ||||
Estimate | P-value | Estimate | OR | 95% CI | P-value | |
Rebleeding laboratory | ||||||
CTP score | 0.61 | < 0.001 | ||||
MELD score | 0.17 | < 0.001 | 0.16 | 1.17 | 1.10-1.25 | < 0.001 |
HE (grade) | 0.76 | < 0.001 | ||||
Cr | 0.61 | 0.001 | ||||
Bil | 0.09 | < 0.001 | ||||
Alb | -1.18 | 0.001 | ||||
Hb | -0.23 | 0.045 | ||||
WBC | 0.15 | < 0.001 | ||||
INR (PT) | 1.85 | < 0.001 | ||||
Rebleeding 5-d failure | 1.96 | < 0.001 | ||||
Hypovolemic shock | 2.94 | < 0.001 | 2.23 | 9.25 | 1.68-50.93 | 0.011 |
Rebleeding EGD finding | -1.47 | 0.011 | ||||
Rebleeding infection | 1.97 | < 0.001 | ||||
Rebleeding Inderal use | -1.51 | 0.001 | -1.7 | 0.18 | 0.05-0.63 | 0.007 |
Table 5 Sensitivity, specificity, positive predictive value, and negative predictive value for predicting 6-wk mortality in patients with rebleeding after endoscopic variceal band ligation for esophageal varices bleeding n (%)
6-wk mortality | Sensitivity | Specificity | PPV | NPV |
MELD score ≥ 21.5 | 77.55 | 81.01 | 71.7 | 85.33 |
Hypovolemic shock (+) | 42.86 | 96.20 | 87.5 | 26.92 |
Beta-blocker use after rebleeding | 83.67 | 46.84 | 49.4 | 82.22 |
- Citation: Chen WT, Lin CY, Sheen IS, Huang CW, Lin TN, Lin CJ, Jeng WJ, Huang CH, Ho YP, Chiu CT. MELD score can predict early mortality in patients with rebleeding after band ligation for variceal bleeding. World J Gastroenterol 2011; 17(16): 2120-2125
- URL: https://www.wjgnet.com/1007-9327/full/v17/i16/2120.htm
- DOI: https://dx.doi.org/10.3748/wjg.v17.i16.2120