title: Predictors of in-hospital mortality after acute variceal bleeding in patients with hepatocellular carcinoma and concurrent main portal vein thrombosis.
abstract: OBJECTIVE
  Risk factors for acute variceal bleeding in patients with hepatocellular carcinoma (HCC) and concurrent main portal vein thrombosis (PVT) remain unclear. We aimed to determine risk factors of in-hospital mortality after acute variceal bleeding for HCC patients with concurrent main PVT.
  
  
  METHODS
  We conducted a retrospective analysis of 102 HCC patients (83% men and 17% women) with concurrent main PVT and acute variceal bleeding. All patients received emergent endoscopy to define the bleeding source. Multivariable Cox proportional hazard regression analysis consisting of clinical, laboratory, and endoscopic parameters was performed to identify predictive factors for intrahospital mortality.
  
  
  RESULTS
  Twenty-eight (27.5%) patients died within admission. The median survival of all patients was 56 days. Multivariable Cox proportional hazard regression analyses revealed Child-Pugh score (adjusted hazard ratio [aHR]: 1.29 for each point; 95% confidence interval [CI]: 1.11-1.50), active bleeding on index endoscopy (aHR: 7.50; 95% CI: 3.05-18.4), esophageal varices as the bleeder (compared with gastric varices, aHR: 14.3; 95% CI: 3.12-66.1), failure to control bleeding (aHR: 38.0; 95% CI: 7.44-194), and serum creatinine (aHR: 1.28 for each increase of 1 mg/dL; 95% CI: 1.09-1.50) independently predicted in-hospital mortality.
  
  
  CONCLUSIONS
  Hepatic reserve, active bleeding on index endoscopy, failure to control bleeding, esophageal varices as the bleeder when compared with gastric varices, and renal function were independent predictive factors for in-hospital mortality in HCC patients with acute variceal bleeding and concurrent main PVT.
authors.affiliation: Department of Internal Medicine, Min-Sheng General Hospital, Taoyan, Taiwan.
authors.forename: Ming-Lun
authors.initials: ML
authors.lastname: Han
authors.forename: Chieh-Chang
authors.initials: CC
authors.lastname: Chen
authors.forename: Shih-Hao
authors.initials: SH
authors.lastname: Kuo
authors.forename: Wen-Feng
authors.initials: WF
authors.lastname: Hsu
authors.forename: Jyh-Ming
authors.initials: JM
authors.lastname: Liou
authors.forename: Ming-Shiang
authors.initials: MS
authors.lastname: Wu
authors.forename: Hsiu-Po
authors.initials: HP
authors.lastname: Wang
mesh_terms: D000208:Acute Disease; D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000401:mortality*; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000401:mortality* / Q000601:surgery; D005260:Female; D005544:Forecasting; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000401:mortality* / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000150:complications* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D012189:Retrospective Studies; D012307:Risk Factors; D020246:Venous Thrombosis / Q000150:complications*
keywords: acute variceal bleeding; endoscopic injection of tissue adhesives; endoscopic variceal ligation; hepatocellular carcinoma; portal vein thrombosis