title: The effectiveness of current acute variceal bleed treatments in unselected cirrhotic patients: refining short-term prognosis and risk factors.
abstract: OBJECTIVE
  The mortality from esophageal variceal hemorrhage in liver cirrhosis patients remains approximately 15-20%. Predictors of short-term outcomes, such as the hepatic venous pressure gradient, are often unavailable in the acute setting. Clinical variables seem to have a similar predictive performance, but some variables including active bleeding during endoscopy have not been reevaluated after the utilization of endoscopic banding as endoscopic procedure. In addition, patients with severe liver failure are often excluded from clinical trials. The aim of this study was to prospectively reevaluate the risk factors affecting a 5-day failure after acute variceal bleeding in unselected cirrhotic patients, managed with the current standard treatment using vasoactive drugs, band ligation, and antibiotics.
  
  
  METHODS
  One hundred and eighty five patients with liver cirrhosis and variceal bleeding admitted from January 2010 to July 2011 were evaluated.
  
  
  RESULTS
  Hepatocellular carcinoma was present in 28.1% of cases and portal vein thrombosis (PVT) was present in 17.3% of cases. Band ligation was feasible in 92.4% of cases. Five-day failure occurred in 16.8% of cases; 12 patients (6.5%) experienced failure to control bleeding or early rebleeding, and 66.7% of patients died within 5 days. The overall 5-day mortality rate was 14.6%. By multivariate analysis, we determined that Child-Pugh class C, a white blood cell count over 10 × 10(9)/l, and the presence of PVT were the only independent predictors of the 5-day failure.
  
  
  CONCLUSIONS
  The prognosis of a consistent group of liver cirrhosis patients with variceal bleeding remains poor. The current treatment is highly effective in controlling variceal bleeding, but mortality is related mainly to the severity of liver failure.
authors.affiliation: Gastroenterology Unit, AORN A. Cardarelli, Naples, Italy. luamitra@tin.it
authors.forename: Lucio
authors.initials: L
authors.lastname: Amitrano
authors.forename: Maria Anna
authors.initials: MA
authors.lastname: Guardascione
authors.forename: Francesco
authors.initials: F
authors.lastname: Manguso
authors.forename: Raffaele
authors.initials: R
authors.lastname: Bennato
authors.forename: Antonio
authors.initials: A
authors.lastname: Bove
authors.forename: Claudio
authors.initials: C
authors.lastname: DeNucci
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lombardi
authors.forename: Rossana
authors.initials: R
authors.lastname: Martino
authors.forename: Antonella
authors.initials: A
authors.lastname: Menchise
authors.forename: Luigi
authors.initials: L
authors.lastname: Orsini
authors.forename: Salvatore
authors.initials: S
authors.lastname: Picascia
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Riccio
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007958:Leukocyte Count; D008103:Liver Cirrhosis / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D017211:Treatment Failure; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications*