title: Improved survival of cirrhotic patients with variceal bleeding over the decade 2000-2010.
abstract: OBJECTIVE
  Advances in the management of variceal bleeding (VB) have been highlighted recently. We aimed at assessing whether changing the management of VB has improved the outcome (mortality and rebleeding rates).
  
  
  METHODS
  The files of two cohorts (n=57, 2000-2001 and n=64, 2008-2009) of patients referred to our university center were reviewed after a cross-searching using two coding systems. Data were recorded during the six months after VB.
  
  
  RESULTS
  As compared to 2000-2001, more use of general anesthesia (25.4% vs. 11.1%; P=0.049), band ligations (96.1% vs. 71.4%; P=0.001), octreotide (95.3% vs. 80.7%; P=0.012) and antibiotic prophylaxis (93.8% vs. 82.5%; P=0.09) were performed in 2008-2009, whereas the number of red-cell units transfused during the hospital stay (4.3 ± 3.2 vs. 7.1 ± 5.7; P=0.005) decreased. Surprisingly, more than 60% of patients reached the emergency department from home without medical assistance in both periods. In 2008-2009, patients had more comorbidities and no patients underwent early-TIPS but the 6-week mortality rate (24.6% vs.10.9%; P=0.048) was lower. The 6-week mortality was associated with high MELD score (HR=1.13; 95%CI: 1.08-1.18) and hypovolemic shock (HR=5.36; 95%CI: 1.96-14.67) at admission. In multivariate analysis adjusted on MELD and comorbidities, the 2008-2009 period (HR: 0.42; 95%CI: 0.20-0.87; P=0.02) was associated with a lower 6-month mortality rate.
  
  
  CONCLUSIONS
  Although cirrhotic patients with VB had more comorbidities in 2008-2009 and received no early-TIPS, their prognosis has improved during this last decade concomitantly to a more intensive care and a lower transfusion strategy.
authors.affiliation: Service d'hépatologie et de soins intensifs digestifs, hôpital Jean-Minjoz, 25030 Besançon cedex, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Vuachet
authors.affiliation: Service d'hépatologie et de soins intensifs digestifs, hôpital Jean-Minjoz, 25030 Besançon cedex, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Cervoni
authors.affiliation: Service de gastro-entérologie, hôpital Jean-Minjoz, 25030 Besançon cedex, France.
authors.forename: Lucine
authors.initials: L
authors.lastname: Vuitton
authors.affiliation: Service d'hépatologie et de soins intensifs digestifs, hôpital Jean-Minjoz, 25030 Besançon cedex, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Weil
authors.affiliation: Service d'hépatologie et de soins intensifs digestifs, hôpital Jean-Minjoz, 25030 Besançon cedex, France.
authors.forename: Stavros
authors.initials: S
authors.lastname: Dritsas
authors.affiliation: Département d'information médical, hôpital Jean-Minjoz, 25030 Besançon cedex, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Dussaucy
authors.affiliation: Service de gastro-entérologie, hôpital Jean-Minjoz, 25030 Besançon cedex, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Koch
authors.affiliation: Service d'hépatologie et de soins intensifs digestifs, hôpital Jean-Minjoz, 25030 Besançon cedex, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Di Martino
authors.affiliation: Service d'hépatologie et de soins intensifs digestifs, hôpital Jean-Minjoz, 25030 Besançon cedex, France. Electronic address: tthevenot@chu-besancon.fr.
authors.forename: Thierry
authors.initials: T
authors.lastname: Thevenot
mesh_terms: D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000401:mortality*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors