Determinants of Re Bleeding and Mortality in Cirrhotic Patients after Variceal Bleeding


Approximately 50% of patients with cirrhosis have gastroesophageal varices and variceal bleeding (VB) from varices occurs in 30% of those patients. The rate of bleeding with known varices is 12 to 15% per year and VB is only 5–11% of all gastrointestinal bleeding1,2 but it is 60–65% of bleeding episodes in cirrhotic patients. Baveno VI consensus conference3 recommended following hemodynamic resuscitation, endoscopic variceal ligation or tissue adhesive should be undergone within 12h of presentation and vasoactive drugs should be started as soon as possible, before endoscopy. Antibiotic prophylaxis is an integral part of therapy for cirrhotic patients presenting with upper gastrointestinal bleeding but it may be voided in CTP class A patients as very low risk of bacterial infection and mortality. Vasoactive drugs (terlipressin, somatostatin, octreotide) should be used in combination with endoscopic therapy to improve outcomes following variceal bleeding.4 VB is a major cause of mortality and morbidity in cirrhotic patients.5,6The risk of re-bleeding within 1 year is approximately 60%.7 Mortality rate from each episode of VB is approximately 15 to 20%8,9 in the past and 10 20% at 6 weeks mortality in the previous study.

 Thus, it is extremely important that patients who survive an initial VB start on prophylactic therapy to prevent future bleedings. Several factors may increase the risk of bleeding such as the size of the varices, presence at endoscopy of red wale markings, the severity of liver disease and active alcohol use.11 Several factors have been identified as predictors of mortality after VB, including bacterial infection, hepatic venous pressure gradient (HVPG) >20 mmHg measured shortly after admission, active bleeding at initial endoscopy, severity of initial bleeding, presence of portal vein thrombosis(PVT), hepatocellular carcinoma (HCC), alcoholic liver disease, early re-bleeding, serum bilirubin and albumin levels, Child-Turcotte-Pugh (CTP) class B or C, and Model for End-stage Liver Disease (MELD) score.12-14 With our hospital data-base, we will analyse patient characters (age, sex, aetiology of cirrhosis, CTP score, MELD score, portal vein thrombosis, ascites), association with HCC and PVT; and different characters of alcoholic cirrhotic patients. We evaluate clinical outcomes including non-controlled bleeding, re-bleeding and mortality at day-5, week-6 and 1-year. Moreover, we identify the risk factors of re-bleeding and mortality of cirrhotic patients after initial variceal bleeding.

https://www.stephypublishers.com/sojcem/pdf/SOJCEM.MS.ID.000515.pdf

Comments

Post a Comment

Popular posts from this blog

Image
 Sustainable Development: Reality Or Myth? Since the United Nations Environment Conference in Stockholm (1972), the concept of sustainable development has steadily made its way among individual scientists and international organizations. The apotheosis of this development was the adoption by the United Nations in 2015 of the 17 Sustainable Development Goals. However, many scientists and politicians were skeptical about the concept of sustainable development, since the results of implementing sustainable development in different countries were far from expected. Many decisions taken at the level of the UN and other international organizations turned out to be unfulfilled. In my opinion, as well as some other Russian scientists, the concept of sustainable development is an unrealistic project, it is a myth, although it is very positive and humane. Sustainable development goals can be achieved only by the most economically developed countries entering the era of post-industrialism. In...
Read more
Image
 How to Treat Cancer Properly Cancer is one of the deadliest diseases in the world, chemotherapy is effective under some conditions, but has too heavy side effects, and it is not effective to a considerable proportion of cases while the side effects are often life-threatening, drugs (not unhealthy addictive drugs mentioned in reference four, the drug in reference four only mean those makes people addictive but does no good to health, destroying health quickly) are not always available to improve the condition. However, sport is a potential treatment that is effective to cancer before the cancer is disseminated, this gets little attention but is true both in theory and practice. The physical activities that have moderate intensity and duration should have devastating effects on cancer cells, they make the body hot and reduce the nutritional resources that cancer cells can get, also renew the proteins in the body and improve one’s mood, cancer cells are hard to live when one is activ...
Read more
Image
 From Bronchial Asthma to Tuberculosis: Unravelling the Cytokine-Macrophage Axis in Diverse Diseases Cytokines, tiny proteins secreted by cells, play a critical role in mediating communication and interactions between cells. They also function as immunomodulating agents, adjusting immune responses. When released into the bloodstream or tissues, cytokines bind to specific receptors on target immune cells, triggering cellular responses. Cytokines are implicated in various diseases, including asthma, COPD, HIV infection, and multiple sclerosis. This review delves into the intricate interplay between cytokines and macrophages, focusing on their roles in inflammation and the immune response. Macrophages, which are scavenger cells of the immune system, exhibit remarkable heterogeneity, reside in diverse tissues, and play crucial roles in both innate and acquired immunity. They can be activated for proinflammatory or anti-inflammatory functions, contributing to tissue destruction or regen...
Read more