Prognostic factors associated with mortality in patients with gastric fundal variceal bleeding

doi:10.3748/wjg.v23.i3.496

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 23, Issue 3

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (9030)

All Articles published online

The chart showing PDF series, WORD series, HTML series, Figures (1-2) series, Tables (1-5) series.

Item

Count

PDF

611

WORD

270

HTML

3933

Figures (1-2)

244

Tables (1-5)

328

Sum=5386

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

1230

Download

2414

Sum=3644

Jan 21, 2017 (publication date) through Apr 10, 2025

Times Cited of This Article

Times Cited (10)

Journal Information of This Article

Publication Name

World Journal of Gastroenterology

ISSN

1007-9327

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Jan 21, 2017; 23(3): 496-504
Published online Jan 21, 2017. doi: 10.3748/wjg.v23.i3.496

Table 1 Baseline demographics and characteristics of patients with gastric fundal variceal bleeding

Parameters	n (%)
Sex ratio (F/M)	13/29
Mean age (yr)	64.9 ± 11.6
Mean follow-up period (d)	631 ± 109.6
History
Smoking (presence/absence)	21/21 (50)
Alcohol (presence/absence)	20/22 (47.6)
Disease conditions
Child-Pugh classification (A/B/C)	4/20/18
Hepatocellular carcinoma (presence/absence)	14/28 (33.3)
Hepatic encephalopathy (presence/absence)	6/36 (14.3)
Form of gastric fundal varices (F1-F2/F3)	4/38
Concurrent esophageal varices (presence/absence)	30/12 (71.4)
Previous treatment of gastric varices (presence/absence)	1/41 (2.4)
Etiology of liver cirrhosis
Hepatitis B	5 (11.9)
Hepatitis C	18 (42.9)
Alcoholic	12 (28.6)
Others	7 (16.6)
Treatment of gastric fundal varices
Success of initial treatment (total success/total failure)	39/3 (92.9)
Endoscopic treatment (EIS) (success/failure)	30/1 (96.7)
Nonendoscopic treatment (success/failure)	8/1 (11.1)
Not applicable	1/1 (50)
Antibiotics (presence/absence)	23/19 (54.8)
Blood transfusion (presence/absence)	38/4 (90.5)
Rebleeding after initial treatment (presence/absence)	10/32 (23.8)
Medications administered before admission
NSAIDs (presence/absence)	5/37 (11.9)
Anticoagulants (presence/absence)	1/41 (2.4)
Proton pump inhibitors (presence/absence)	14/28 (33.3)
Blood test results
Hemoglobin (g/dL)	8.7 ± 1.8
Albumin (g/dL)	2.54 ± 0.44
Bilirubin (mg/dL)	1.98 ± 1.44

Results are presented as mean ± SEM, if applicable. EIS: Endoscopic injection sclerotherapy; NSAIDs: Non-steroidal anti-inflammatory drugs.

Table 2 Factors associated with 90-d mortality related to gastric fundal variceal bleeding

Parameters	Univariate analysis				Multivariate analysis
Parameters	β	P value	R	HR (95%CI)	β	P value	R	HR (95%CI)
Sex (F/M)	0.2393	0.7354	0	1.27 (0.32-5.09)
Age (yr)	0.0291	0.3215	0	1.03 (0.97-1.09)
History
Smoking	0.5698	0.4208	0	1.77 (0.44-7.08)
Alcohol	0.1163	0.8624	0	0.89 (0.24-3.32)
Disease conditions
Child-Pugh classification (C/B/A)	0.7513	0.1991	0	2.12 (0.67-6.67)
Hepatocellular carcinoma	1.6422	0.0209¹	0.23	5.17 (1.28-20.8)	2.3041	0.0092¹	0.28	10.01 (1.77-56.74)
Hepatic encephalopathy	0.8163	0.3115	0	2.26 (0.47-10.99)
Form of GFV (F2 or F3/F1)	−0.263	0.8046	0	0.77 (0.10-6.16)
Concurrent esophageal varices	−0.233	0.7422	0	0.79 (0.20-3.17)
Etiology of liver cirrhosis (non-viral/viral)	−1.215	0.1302	−0.07	0.30 (0.06-1.43)
Treatment of GFV
Success of initial treatment	−2.176	0.0081¹	−0.28	0.11 (0.02-0.57)
Initial treatment (non-EIS/EIS/none)	0.0253	0.9726	0	1.03 (0.24-4.36)
Antibiotics	−1.637	0.0413¹	−0.18	0.19 (0.04-0.94)	−2.5412	0.0086¹	−0.28	0.08 (0.01-0.52)
Blood transfusion	3.1861	0.4892	0	1.96 (0.32-14.68)
Rebleeding after initial treatment	1.5956	0.0177¹	0.24	4.94 (1.32-18.42)
Medications before admission
NSAIDs	0.5802	0.4697	0	1.79 (0.37-8.61)
Proton pump inhibitors	1.5316	0.0306¹	0.2	4.63 (1.15-18.53)	2.5465	0.0053¹	0.29	12.76 (2.13-76.52)
Blood test results
Hemoglobin (g/dL)	−0.012	0.9458	0	0.99 (0.70-1.39)
Albumin (g/dL)	−1.429	0.0951	−0.11	0.24 (0.04-1.28)
Bilirubin (mg/dL)	0.1916	0.3572	0	1.21 (0.81-1.82)

¹P < 0.05. Hazard risk ratios were calculated using a Cox proportional hazard model. HR: Hazard risk ratio; GFV: Gastric fundal varices; EIS: Endoscopic injection sclerotherapy; NSAIDs: Nonsteroidal anti-inflammatory drugs.

Table 3 Factors associated with overall survival related to gastric fundal variceal bleeding

Parameters	Univariate analysis				Multivariate analysis
Parameters	β	P value	R	HR (95%CI)	β	P value	R	HR (95%CI)
Sex (F/M)	0.1107	0.8404	0	1.12 (0.38-3.28)
Age (yr)	0.0152	0.5056	0	0.98 (0.94-1.03)
History
Smoking	0.5678	0.3014	0	1.76 (0.60-5.18)
Alcohol	0.3031	0.5591	0	1.35 (0.49-3.74)
Disease conditions
Child-Pugh classification (C/B/A)	0.9924	0.0366¹	0.15	2.70 (1.06-6.84)
Hepatocellular carcinoma	1.8351	0.0013¹	0.29	6.27 (2.05-19.17)	2.0666	0.0035¹	0.26	7.89 (1.98-31.58)
Hepatic encephalopathy	0.5089	0.4391	0	1.66 (0.46-6.04)
Form of GFV (F2 or F3/F1)	0.3475	0.7379	0	1.42 (0.18-10.85)
Concurrent esophageal varices	−0.098	0.8596	0	0.91 (0.31-2.67)
Etiology of liver cirrhosis (non-viral/viral)	−0.086	0.8688	0	0.92 (0.33-2.54)
Treatment of GFV
Success of initial treatment	−2.176	0.0081¹	−0.22	0.11 (0.02-0.57)
Initial treatment (non-EIS/EIS/none)	0.0496	0.9356	0	1.05 (0.32-3.50)
Antibiotics	−0.81	0.0512	−0.07	0.44 (0.16-1.25)	−1.3103	0.0341¹	−0.16	0.27 (0.08-0.91)
Blood transfusion	0.5432	0.6012	0	1.72 (0.22-13.18)
Rebleeding after initial treatment	1.3669	0.0087¹	0.22	3.92 (1.41-10.89)
Medications administered before admission
NSAIDs	1.0131	0.0877	0.1	2.75 (0.86-8.81)	1.2391	0.1184	0.07	3.45 (0.73-16.35)
Proton pump inhibitors	1.4012	0.0084¹	0.22	4.06 (1.43-11.52)	2.3901	0.0005¹	0.32	10.91 (2.86-41.65)
Blood test results
Hemoglobin (g/dL)	−0.062	0.6398	0	0.94 (0.72-1.22)
Albumin (g/dL)	−1.081	0.0915	−0.09	0.34 (0.10-1.19)
Bilirubin (mg/dL)	0.3065	0.0514	0.13	1.36 (0.99-1.85)	0.4224	0.0535	0.13	1.53 (0.99-2.34)

¹P < 0.05. Hazard risk ratios calculated using a Cox proportional hazard model. GFV: Gastric fundal varices; EIS: Endoscopic injection sclerotherapy; NSAIDs: Nonsteroidal anti-inflammatory drugs.

Table 4 Baseline characteristics of patients with gastric fundal variceal bleeding in the antibiotic vs nonantibiotic group

Parameters	Antibiotic group	Non-antibiotic group	P value
Parameters	(n = 23)	(n = 19)	P value
Sex ratio (F/M)	5/18	8/11	0.1925
Mean age (yr)	64.4 ± 13.07	65.47 ± 9.83	0.7673
History
Smoking (presence/absence)	12/11	9/10	1
Alcohol (presence/absence)	12/11	8/11	0.5512
Disease conditions
Child-Pugh classification (A/B/C)	2/13/8	2/7/10	NA
Hepatocellular carcinoma (presence/absence)	7/16	7/12	0.7483
Hepatic encephalopathy (presence/absence)	1/22	5/14	0.0754
Form of gastric fundal varices ( F2-F3/F1)	21/2	17/2	1
Concurrent esophageal varices (presence/absence)	17/6	13/6	0.7422
Previous treatment of GV (presence/absence)	0/23	1/18	0.4524
Etiology of liver cirrhosis
Non-viral/viral	9/14	10/9	0.5347
Treatment of gastric fundal varices
Success of initial treatment (success/failure)	22/1	17/2	0.5813
Antibiotics (presence/absence)	23/0	0/19	< 0.0001^a
Blood transfusion (presence/absence)	22/1	16/3	0.3129
Medications before admission
NSAIDs (presence/absence)	2/21	3/16	0.6440
Anticoagulant (presence/absence)	0/23	1/18	0.4524
Proton pump inhibitors (presence/absence)	8/15	6/13	1
Blood test results
Hemoglobin (g/dL)	8.97 ± 1.99	8.30 ± 1.63	0.2472
Albumin (g/dL)	2.56 ± 0.47	2.50 ± 0.39	0.6125
Bilirubin (mg/dL)	1.89 ± 1.41	2.09 ± 1.49	0.6616

Antibiotic group: patients with gastric fundal variceal (GFV) bleeding who were administered prophylactic antibiotics; Nonantibiotic group: patients with GFV bleeding patients who did not receive antibiotics.

^aP < 0.05. NA: Not applicable; GV: Gastric varices; NSAIDs: Nonsteroidal anti-inflammatory drugs.

Table 5 Baseline demographics and characteristics of patients in the proton pump inhibitors vs non- proton pump inhibitors group

Parameters	PPI group	Non-PPI group	P value
Parameters	(n = 14)	(n = 28)	P value
Sex ratio (F/M)	6/8	7/21	0.2980
Mean age (yr)	61.9 ± 13.36	66.4 ± 10.53	0.2364
History
Smoking (presence/absence)	8/6	13/15	0.7442
Alcohol (presence/absence)	7/7	13/15	1
Disease conditions
Child-Pugh classification (A/B/C)	0/6/8	4/14/10	0.2122
Hepatocellular carcinoma (presence/absence)	6/8	8/20	0.4899
Hepatic encephalopathy (presence/absence)	2/12	4/24	1
Form of gastric fundal varices (F2-F3/F1)	2/12	2/26	0.5902
Concurrent esophageal varices (presence/absence)	7/7	23/5	0.0666
Previous treatment of GV (presence/absence)	0/14	1/27	1
Etiology of liver cirrhosis
Non-viral/viral	4/10	15/13	0.1905
Treatment of gastric fundal varices
Success of initial treatment (success/failure)	12/2	27/1	0.2537
Antibiotics (presence/absence)	8/6	15/13	1
Blood transfusion (presence/absence)	13/1	25/3	1
Medications before admission
NSAIDs (presence/absence)	4/24	1/13	0.6496
Anticoagulants (presence/absence)	1/13	0/28	0.3333
Proton pump inhibitors (presence/absence)	14/0	0/28	< 0.0001^a
Blood test results
Hemoglobin (g/dL)	8.65 ± 1.59	8.68 ± 1.99	0.4792
Albumin (g/dL)	2.34 ± 0.39	2.64 ± 0.43	0.0314^a
Bilirubin (mg/dL)	2.00 ± 1.39	1.97 ± 1.48	0.5238

PPI group: patients with gastric fundal variceal (GFV) bleeding who were administered proton pump inhibitors; Non-PPI group: patients with GFV bleeding who did not receive proton pump inhibitors.

^aP < 0.05. NA: Not applicable; GV: Gastric varices; NSAIDs: Nonsteroidal anti-inflammatory drugs; PPI: Proton pump inhibitors.

Citation: Komori K, Kubokawa M, Ihara E, Akahoshi K, Nakamura K, Motomura K, Masumoto A. Prognostic factors associated with mortality in patients with gastric fundal variceal bleeding. World J Gastroenterol 2017; 23(3): 496-504
URL: https://www.wjgnet.com/1007-9327/full/v23/i3/496.htm
DOI: https://dx.doi.org/10.3748/wjg.v23.i3.496