Bleeding index after the first course of endoscopic treatment for esophageal varices in liver cirrhotic patients with and without hepatocellular carcinoma.
OBJECTIVE
We retrospectively evaluated variable clinical data on admission to reliably predict bleeding from esophageal varices after the first course of endoscopic treatment in liver cirrhosis patients with and without hepatocellular carcinoma.


METHODS
We analyzed 27 clinical factors from the medical records of 118 patients who received their first course of endoscopic treatment for esophageal varices. Factors significantly related to bleeding were extracted using Cox's regression model, and the bleeding index was prepared by combining these factors.


RESULTS
The cumulative nonbleeding rates after treatment for esophageal varices were 82.1% at 1 year, 64.6% at 3 years and 53.7% at 5 years. By the multivariate analysis, age, the presence of hepatocellular carcinoma, hemoglobin, lactate dehydrogenase and alpha-fetoprotein were selected as significant factors that contributed independently to the post-therapeutic bleeding from esophageal varices (P<0.05). The bleeding index was calculated using the following formula: bleeding index = - 0.045 x Age + 0.934 x hepatocellular carcinoma - 0.151 x hemoglobin + 0.108 x lactate dehydrogenase + 0.842 x alpha-fetoprotein.


CONCLUSIONS
The bleeding index, based on 5 factors, will in future be an appropriate index to predict the post-therapeutic bleeding from esophageal varices.
Kogo
Mari
M
Department of Pathophysiology, Showa University School of Pharmaceutical Sciences, Shinagawa-ku, Tokyo 142-8555, Japan. mari-k@pharm.showa-u.ac.jp
Sato
Naka
N
Yoneyama
Keiichiro
K
Imawari
Michio
M
Kiuchi
Yuji
Y
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000175:diagnosis; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D008113:Liver Neoplasms / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012189:Retrospective Studies