Prognostic factors associated with rebleeding in cirrhotic inpatients complicated with esophageal variceal bleeding.

Background: Esophageal variceal bleeding is a frequent and severe complication in patients with cirrhosis. The aim of this study was to identify prognostic factors of esophageal variceal rebleeding in cirrhotic inpatients.

Methods: Consecutive cirrhotic patients who were admitted to Changhai Hospital because of esophageal variceal bleeding were retrospectively analyzed. To assess the independent factors for recurrent hemorrhage after esophageal variceal bleeding, medical assessment was completed at the time of their initial hospital admission, including documentation of clinical, biochemical, and treatment methods that might contribute to variceal rebleeding. Univariate and multivariate analyses were retrospectively performed.

Results: Totally 186 patients (35.8%) were assigned to a rebleeding group and the other 334 patients (64.2%) to a non-rebleeding group. Multivariate stepwise regression analysis showed that four variables were positively correlated with rebleeding: Child-pugh grade B (OR = 2.664, 95%CI 1.680 - 4.223) (compared with Child-pugh grade A), total bilirubin (Tbil) (OR = 1.0006, 95%CI 1.002 - 1.0107), creatinine (OR = 1.008, 95%CI 1.002 - 1.015) and the cumulative volume of blood transfusion (OR = 1.519, 95%CI 1.345 - 1.716). The presence of ascites (OR = 0.270, 95%CI 0.136 - 0.536) and prophylactic antibiotics (OR = 0.504, 95%CI 0.325 - 0.780) were negatively correlated with rebleeding of the cirrhotic inpatients. According to standardized coefficient, the importance of rebleeding predictors ranked from the most to the least was as follows: the cumulative volume of blood transfusion, Child-pugh grade B, Tbil and creatinine.

Conclusion: Rebleeding in cirrhotic inpatients was associated with more blood transfusions, Child-pugh grade B, higher Tbil and creatinine.