title: Factors participating in the development and mortality of variceal bleeding in portal hypertension--possible effects of the kidney damage and malnutrition.
abstract: 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.
authors.affiliation: Department of Internal Medicine and Gastroenterology, University Hospital Brno, Jihlavska 20 625 00 Brno, Czech Republic. jlata@fnbrno.cz
authors.forename: Jan
authors.initials: J
authors.lastname: Lata
authors.forename: Libuse
authors.initials: L
authors.lastname: Husová
authors.forename: Jana
authors.initials: J
authors.lastname: Juránková
authors.forename: Michal
authors.initials: M
authors.lastname: Senkyrík
authors.forename: Petr
authors.initials: P
authors.lastname: Díte
authors.forename: Milan
authors.initials: M
authors.lastname: Dastych
authors.forename: Milan
authors.initials: M
authors.lastname: Dastych
authors.forename: Radek
authors.initials: R
authors.lastname: Kroupa
mesh_terms: 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
chemical_list: D014508:Urea; D001663:Bilirubin