Prognosis of hepatic cirrhosis patients with esophageal or gastric variceal hemorrhage: multivariate analysis.
OBJECTIVE
To study the effect of bacterial infection, use of antibiotics, active bleeding at endoscopy, and the severity of liver disease as prognostic factors in hepatic cirrhotic patients during the first 5 days after the episode of esophageal or gastric variceal hemorrhage.


METHODS
Seventy-six hepatic cirrhosis patients with esophageal or gastric variceal bleeding were enrolled. Bleeding was managed in a standardized protocol using octreotide and vasopressin in sclerotherapy or band ligation for active bleeding at endoscopy. The screening protocol for bacterial infection consisted of chest radiograph; blood, urine and ascitic fluid cultures; the severity of liver disease shown by Child-Pugh score.


RESULTS
Active bleeding was observed at endoscopy in 40 patients (53%). Failure to control bleeding within 5 days occurred in 36 patients (45%). Empirical antibiotic treatment was used in 53 patients (67%), whereas bacterial infections were documented in 43 patients (57%). Multivariate analysis showed that proven bacterial infection (P<0.01) or antibiotic use (P<0.05) as well as active bleeding at endoscopy (P<0.01) and Child-Pugh score (P<0.01) were independent prognostic factors of failure to control bleeding.


CONCLUSIONS
Bacterial infection is associated with failure to control esophageal or gastric variceal bleeding in hepatic cirrhotic patients.
Zhao
Chao
C
Department of Gastroenterology, Zhongshan Municipal Bo'ai Hospital, Zhongshan 528403, China. zc1963@sohu.com
Chen
Shao-Bo
SB
Zhou
Jian-Pin
JP
Xiao
Wen
W
Fan
Han-Gong
HG
Wu
Xue-Wei
XW
Feng
Gan-Xin
GX
He
Wei-Xiong
WX
D001424:Bacterial Infections / Q000209:etiology; D016145:Endoscopy, Digestive System; D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000473:pathology; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000209:etiology; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology; D015999:Multivariate Analysis; D011379:Prognosis; D012008:Recurrence; D012720:Severity of Illness Index; D017211:Treatment Failure
D006490:Hemostatics