Factors participating in the development and mortality of variceal bleeding in portal hypertension--possible effects of the kidney damage and malnutrition.
OBJECTIVE
Acute bleeding from esophageal varices due to portal hypertension is a frequent and severe complication of liver cirrhosis. The development of esophageal varices as well as their rupture depends on the level of portal pressure; however, a number of other factors may play a negative role in the rise of bleeding and its prognosis.


METHODS
The report presented has compared a set of 46 patients admitted to hospital for acute bleeding with 48 cirrhotics hospitalized for other reasons.


RESULTS
Bleeding patients had significantly higher level of nitrogenous substances (urea 14.1 mmol/L vs. 7.78 mmol/L, p < 0.01, creatinine 129.8 micromol/L vs. 106.04 micromol/L; p = 0.09). The disturbed renal function in itself probably does not increase the risk of bleeding, it may be rather considered a certain prognostic index of the portal hypertension degree. Bleeding patients had a lower level of total protein (60.7 g/L vs. 69.9 g/L; p < 0.01) with only slight insignificant decrease of albumin (26.64 g/L vs. 28.51 g/L). Cirrhotic patients are known to suffer from malnutrition and it is possible that malnutrition shares negatively and directly in the rise of bleeding.


CONCLUSIONS
A prognostic index of mortality was a more conspicuous disorder of hepatic function (bilirubin 97.4 micromol/L vs. 57.4 micromol/L; p = 0.1; prolonged prothrombin time 1.99 INR vs. 1.56 INR; p = 0.01) and again the disorder of renal function (creatinine 166.7 micromol/L vs. 114.9 micromol/L; p = 0.09). Therefore, the maintenance of good renal function must be a component of complex therapy given to bleeding patients.
Lata
Jan
J
Department of Internal Medicine and Gastroenterology, University Hospital Brno, Jihlavska 20 625 00 Brno, Czech Republic. jlata@fnbrno.cz
Husová
Libuse
L
Juránková
Jana
J
Senkyrík
Michal
M
Díte
Petr
P
Dastych
Milan
M
Dastych
Milan
M
Kroupa
Radek
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000097:blood; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000209:etiology* / Q000401:mortality*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000209:etiology* / Q000401:mortality*; D006400:Hematocrit; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood / Q000209:etiology* / Q000401:mortality; D007674:Kidney Diseases / Q000097:blood / Q000150:complications*; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000401:mortality; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000150:complications*; D008875:Middle Aged; D011517:Prothrombin Time; D012307:Risk Factors; D016019:Survival Analysis; D014508:Urea / Q000097:blood
D014508:Urea; D001663:Bilirubin