Optimizing the time-frame for the definition of bleeding-related death after acute variceal bleeding in cirrhosis.
OBJECTIVE
To identify the best time-frame for defining bleeding-related death after variceal bleeding in patients with cirrhosis.


METHODS
Prospective long-term evaluation of a cohort of 155 patients admitted with variceal bleeding.


METHODS
Eight medical departments in seven hospitals in north-eastern Italy.


METHODS
Non-linear regression analysis of a hazard curve for death, and Cox's multiple regression analyses using different zero-time points.


RESULTS
Cumulative hazard plots gave two slopes, the first corresponding to the risk of death from acute bleeding, the second a baseline risk of death. The first 30 days were outside the confidence limits of the regression curve for the baseline risk of death. Using Cox's regression analysis, the significant predictors of overall mortality risk were balanced between factors related to severity of bleeding and those related to severity of liver disease. If only deaths occurring after 30 days were considered, only predictors related to the severity of liver disease were found to be of importance.


CONCLUSIONS
Thirty days after bleeding is considered to be a reasonable time-frame for the definition of bleeding-related death in patients with cirrhosis and variceal bleeding.
Merkel
C
C
Department of Clinical Medicine, University of Padua, Italy.
Gatta
A
A
Bellumat
A
A
Bolognesi
M
M
Borsato
L
L
Caregaro
L
L
Cavallarin
G
G
Cielo
R
R
Cristina
P
P
Cucci
E
E
Donada
C
C
Donadon
V
V
Enzo
E
E
Martin
R
R
Mazzaro
C
C
Sacerdoti
D
D
Torboli
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D007558:Italy / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors