Predictors of variceal bleed among patients with liver cirrhosis in the era of sclerotherapy.
BACKGROUND
Variceal bleed is a common complication of portal hypertension. The bleed pattern has changed considerably with the introduction of variceal band ligation. The bleed pattern in developing countries where sclerotherapy continues to remain a viable option is not known. The aim of the study was to determine the predictors of first and subsequent bleed in individuals with liver cirrhosis.


METHODS
205 subjects with liver cirrhosis and portal hypertension registered in the liver clinic between January and June 2004, were followed-up for 18 months after registration. Bleeders already on pharmacotherapy or endotherapy were excluded. Patient details included age, gender, duration of illness, aetiology, Child-Pugh-Turcotte score and grades of oesophageal varices, details of index and subsequent variceal bleed, and complications during follow-up. Logistic regression multivariate analysis was applied to predict the factors influencing variceal bleed.


RESULTS
There were 95 variceal bleeders and 110 non-bleeders. Age at presentation and gender did not predict a variceal bleed. Grades III and IV oesophageal varices and fundal varices were the significant risk factors for an index bleed (p-value is 0.001). 27 of the 95 bleeders (28.3 percent) had a second bleed after a mean interval of 8 (+/- 7.7) months. Predictors of rebleed were similar to the index bleed. Predictors of index bleed were also similar to those who had bled for the first time after registration. Overall bleed-related mortality was low (2.1 percent).


CONCLUSIONS
Higher grades of varices, presence of cherry-red spots and fundal varices predicted variceal bleed in patients with liver cirrhosis. Variceal bleed-related mortality was low in the era of sclerotherapy.
Varghese
J
J
Department of Medical Gastroenterology, Stanley Medical College Hospital, Old Jail Road, Royapuram, Chennai 600001, Tamil Nadu, India. joyvargese@gmail.com
Cherian
J V
JV
Solomon
R
R
Jayanthi
V
V
D000328:Adult; D003906:Developing Countries; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000209:etiology / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000209:etiology; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications*; D016015:Logistic Models; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015911:Sclerotherapy / Q000295:instrumentation / Q000379:methods*