title: Risk factors for early rebleeding and mortality in acute variceal hemorrhage.
abstract: OBJECTIVE
  To investigate the risk factors for 6-wk rebleeding and mortality in acute variceal hemorrhage (AVH) patients treated by percutaneous transhepatic variceal embolization (PTVE).
  
  
  METHODS
  A retrospective cohort study of AVH patients who had undergone PTVE treatment was conducted between January 2010 and December 2012. Demographic information, medical histories, physical examination findings, and laboratory test results were collected. The PTVE procedure was performed as a rescue therapy for patients who failed endoscopic and pharmacologic treatment. Survival analysis was estimated using the Kaplan-Meier method and compared using the log-rank test. The multivariate analysis was performed using the Cox regression test to identify independent risk factors for rebleeding and mortality.
  
  
  RESULTS
  One hundred and one patients were included; 71 were males and the average age was 51 years. Twenty-one patients rebled within 6 wk. Patients with high-risk stigmata, PTVE with trunk obliteration, and a hepatic vein pressure gradient (HVPG) ≥ 20 mmHg were at increased risk for rebleeding (OR = 5.279, 95%CI: 2.782-38.454, P = 0.003; OR = 4.309, 95%CI: = 2.144-11.793, P < 0.001; and OR = 1.534, 95%CI: 1.062-2.216, P = 0.022, respectively). Thirteen patients died within 6 wk. A model for end-stage liver disease (MELD) score ≥ 18 and an HVPG ≥ 20 mmHg were associated with 6-wk mortality (OR = 2.162, 95%CI: 1.145-4.084, P = 0.017 and OR = 1.423, 95%CI: 1.222-1.657, P < 0.001, respectively).
  
  
  CONCLUSIONS
  MELD score and HVPG in combination allow for early identification of patients with AVH who are at substantially increased risk of death over the short term.
authors.affiliation: Jing-Run Zhao, Guang-Chuan Wang, Jin-Hua Hu, Chun-Qing Zhang, Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China.
authors.forename: Jing-Run
authors.initials: JR
authors.lastname: Zhao
authors.affiliation: Jing-Run Zhao, Guang-Chuan Wang, Jin-Hua Hu, Chun-Qing Zhang, Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China.
authors.forename: Guang-Chuan
authors.initials: GC
authors.lastname: Wang
authors.affiliation: Jing-Run Zhao, Guang-Chuan Wang, Jin-Hua Hu, Chun-Qing Zhang, Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China.
authors.forename: Jin-Hua
authors.initials: JH
authors.lastname: Hu
authors.affiliation: Jing-Run Zhao, Guang-Chuan Wang, Jin-Hua Hu, Chun-Qing Zhang, Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China.
authors.forename: Chun-Qing
authors.initials: CQ
authors.lastname: Zhang
mesh_terms: D000208:Acute Disease; D000328:Adult; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000401:mortality*; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017082:Portal Pressure; D011169:Portal Vein / Q000503:physiopathology; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute variceal hemorrhage; Hepatic vein pressure gradient; Percutaneous transhepatic variceal embolization