Factors influencing clinical outcomes of Histoacryl® glue injection-treated gastric variceal hemorrhage

Table 1 Patient baseline characteristics and clinical presentation n (%)

Clinical factor	n = 90	mean ± SD
Age, yr		55.9 ± 13.9
Male sex	67 (74.4)
Clinical presentations
Hematemesis	64 (71.1)
Melena	11 (12.2)
Hematochezia	6 (6.7)
Coffee ground	8 (8.9)
Not reported	1 (1.1)
Vital signs at presentation
Normal	49 (54.4)
Tachycardia	7 (7.8)
Hypotension	34 (37.8)
Etiology of cirrhosis
Alcoholism	31 (34.4)
Chronic hepatitis B	26 (28.9)
Chronic hepatitis C	13 (14.4)
Nonalcoholic steatohepatitis	2 (2.2)
Cryptogenic	11 (12.2)
Other	7 (7.8)
Liver status by Child-Pugh classification
Class A	18 (20.0)
Class B	42 (46.7)
Class C	29 (32.2)
Concurrent hepatocellular carcinoma
Yes	29 (32.2)
Blood transfusion
Yes	81 (90.0)
Transfusion volume
Packed red cells, units		3.5 ± 2.8
Fresh frozen plasma, mL		890.9 ± 1183.4
Endoscopic setting
Emergency	66 (73.3)
Urgent	24 (26.7)

Table 2 Procedures, clinical outcomes, and complications n (%)

Procedures and clinical factors	n = 90	mean ± SD
Type of gastric varix
GOV1	40 (44.4)
GOV2	30 (33.3)
IGV1	18 (20.0)
IGV2	1 (1.1)
Combination of variceal type	1 (1.1)
Size of gastric varices, cm		2.1 ± 0.9
Concurrent esophageal varix
No	28 (31.1)
Yes	62 (68.9)
Bleeding stigmata observed by endoscopy
Yes	71 (78.9)
Initial hemostasis
Yes	88 (97.8)
Early re-bleeding
Yes	9 (10.0)
Late re-bleeding
Yes	19 (21.1)
Early complications
No	77 (85.6)
Non-significant systemic embolization	4 (4.4)
Pneumonia	4 (4.4)
Spontaneous bacterial peritonitis	1 (1.1)
Infection elsewhere	3 (3.3)
Late complications
No	88 (97.8)
Infection elsewhere	1 (1.2)
Mean aliquot used/procedure		3.0 ± 1.7
Follow-up clinical status
Dead	19 (21.1)
Worsening	3 (3.3)
Stable	8 (8.9)
Improved	60 (66.7)
Causes of death (n = 19)
Bleeding-related	4 (4.4)
Infection	9 (10.0)
Liver failure	1 (1.1)
Cardiovascular diseases	2 (2.2)
Renal failure	1 (1.1)
Bowel gangrene	2 (2.2)

Table 3 Factors related to early re-bleeding

Factors	Early re-bleeding
			Univariate			Multivariate
	Yes (n = 9)	No (n = 81)	P value	95%CI	OR	P value	95%CI	OR
Decompensated liver diseases
Yes	9	62	0.19
MELD score > 12	3	19	0.69
Encephalopathy	3	24	0.33
Ascites	8	33	0.011	1.30-91.51	10.9	0.031	1.27-89.52	10.67
Concurrent HCC
Yes	6	23	0.05	1.14-21.50	4.95
Transfusion volume
PRC, unit	6.89 ± 3.85	3.09 ± 2.56	< 0.011			0.041	1.12-116.0	11.41
FFP, mL	1943.33 ± 1064.61	773.69 ± 1142.92	< 0.011			-	-	-
Type of gastric varix
GOV	7	63
IGV	2	17	0.99
Mean GV size, cm	2.16 ± 0.70	2.12 ± 0.88	0.88
Mean aliquot number/procedure	3.88 ± 1.72	2.93 ± 1.72	0.146
Endoscopic red stigmata
Yes	9	69	0.19

¹Statistically significant difference. HCC: Hepatocellular carcinoma; MELD: Model of end-stage liver disease; PRC: Packed red cell; FFP: Fresh frozen plasma; OR: Odds ratio.

Table 4 Factors related to late re-bleeding

Factors	Late re-bleeding
			Univariate			Multivariate
	Yes (n = 19)	No (n = 71)	P value	95%CI	OR	P value	95%CI	OR
Decompensated liver diseases
Yes	18	53	0.19
MELD score > 12	5	17	0.92
Encephalopathy	7	10	0.07
Ascites	14	27	0.011	1.37-13.17	4.25	0.011	1.34-12.86	4.15
Concurrent HCC
Yes	10	19	0.041	1.05-8.46	2.98	-	-	-
Transfusion volume
PRC, unit	5.00 ± 3.59	3.06 ± 2.36	< 0.011			-	-	-
FFP, mL	1648.68 ± 1720.18	688.11 ± 906.73	0.031			-	-	-
Type of gastric varix
GOV	14	56	0.89
IGV	5	15
Mean GV size, cm	2.05 ± 0.76	2.15 ± 0.89	0.67
Mean aliquot number/procedure	3.17 ± 1.75	2.98 ± 1.74	0.69
Endoscopic red stigmata
Yes	17	54	0.55

¹Statistically significant difference. HCC: Hepatocellular carcinoma; MELD: Model of end-stage liver disease; PRC: Packed red cell; FFP: Fresh frozen plasma; OR: Odds ratio.

Table 5 Correlation analysis of factors associated with mortality at final follow-up

Factors	Mortality
			Univariate			Multivariate
	Yes (n = 19)	No (n = 71)	P value	95%CI	OR	P value	95%CI	OR
Age, yr	56.4 ± 3.34	55.8 ± 1.65	0.95
Decompensated liver diseases
Yes	18	53	0.10
MELD score > 12	8	14	0.06
Ascites	13	28	0.041	1.05-9.12	3.09	-	-	-
Encephalopathy	6	11	0.29
Total bilirubin, mg/dL	8.50 ± 6.71	2.73 ± 2.93	< 0.011			< 0.011	3.28-85.09	16.7
Concurrent HCC
Yes	10	19	0.031	1.05-8.47	2.98	-	-	-
Transfusion volume
PRC, unit	5.68 ± 3.32	2.87 ± 2.28	< 0.011			-	-	-
FFP, mL	1934.00 ± 1850.78	611.76 ± 724.89	< 0.011			0.031	1.000-1.002	1.001
Type of gastric varix
GOV	14	56	0.54
IGV	5	14
Mean GV size, cm	1.97 ± 0.74	2.16 ± 0.89	0.38
Mean aliquot number/procedure	4.13 ± 1.99	2.76 ± 1.57	< 0.011			-	-	-
Early re-bleeding
Yes	7	2	< 0.011	3.72-108.3	20.12	-	-	-
Late re-bleeding
Yes	8	11	< 0.011	3.35-34.91	10.32	< 0.011	2.15-56.35	10.99

¹Statistically significant difference. HCC: Hepatocellular carcinoma; MELD: Model of end-stage liver disease; PRC: Packed red cell; FFP: Fresh frozen plasma; OR: Odds ratio.

Table 6 Correlation analysis of factors associated with procedure-related complications

Factors	Complications
			Univariate			Multivariate
	Yes (n = 16)	No (n = 74)	P value	95%CI	OR	P value	95%CI	OR
Age, yr	55.92 ± 12.56	56.06 ± 19.69	0.97
Decompensated liver diseases
Yes	14	57	0.19
MELD score > 12	8	14	0.14
Encephalopathy	1	16	0.06
Ascites	8	33	0.79
Concurrent HCC
Yes	5	24	0.90
Mean GV size, cm	2.28 ± 0.99	2.09 ± 0.83	0.44
Mean aliquot number/procedure	2.87 ± 1.50	3.06 ± 1.79	0.71
Early re-bleeding
Yes	4	5	0.49
Late re-bleeding
Yes	7	12	0.041	1.25-12.87	4.01

¹Statistically significant difference. HCC: Hepatocellular carcinoma; MELD: Model of end-stage liver disease; OR: Odds ratio.