title: Independent factors associated with recurrent bleeding in cirrhotic patients with esophageal variceal hemorrhage.
abstract: BACKGROUND, PURPOSE, AND METHODS: Cirrhotic patients with acute esophageal variceal (EV) hemorrhage are characterized by high mortality and rebleeding rates. This study was conducted to investigate the independent indicators of recurrent hemorrhage in cirrhotic patients within 6 weeks after cessation of initial EV bleeding. Ninety-seven consecutive cirrhotic patients with EV bleeding, but without evidence of infection, who were admitted to our hospital between December 2005 and February 2008 were retrospectively analyzed. Among these patients, 14 patients with recurrent hemorrhage and 83 without rebleeding within 6 weeks were enrolled as the rebleeding group and non-rebleeding group, respectively.
  
  
  RESULTS
  The incidence of infection and number of EV ligations were significantly higher in the rebleeding group than in the non-rebleeding group (P=0.043 and 0.042, respectively). Other parameters, such as age, gender, etiology and severity of liver cirrhosis, ascites, spleen diameter, laboratory data, hepatocellular carcinoma, portal vein thrombosis, peptic ulcer disease, blood pressure, requirements of blood transfusion and differential vasoactive mediations, had no significant influence on the incidence of rebleeding. The ratio of mortality (7/14 vs. 3/83) was significantly higher in the rebleeding group (P=0.0002), and these cases were caused by rebleeding and sepsis. The frequency of rebleeding and mortality mostly occurred within the first 2 weeks after admission.
  
  
  CONCLUSIONS
  This study provides evidence that early recurrent hemorrhage after initial EV bleeding in cirrhotic patients is significantly associated with higher incidence of bacterial infection and more numbers of EV ligations due to extensive surface area of mucosal injury and post-banding ulcers. Prevention of rebleeding and infection plays a major role in reducing the rate of mortality in cirrhotic patients with EV bleeding.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, Taichung Veterans General Hospital, 160, Section 3, Taichung Harbor Road, Taichung 407, Taiwan. ericest@vghtc.gov.tw
authors.forename: Shou-Wu
authors.initials: SW
authors.lastname: Lee
authors.forename: Teng-Yu
authors.initials: TY
authors.lastname: Lee
authors.forename: Chi-Sen
authors.initials: CS
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000150:complications; D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D006801:Humans; D008026:Ligation / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome