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Prognosis of hepatic cirrhosis patients with esophageal or gastric variceal hemorrhage: multivariate analysis |
Chao Zhao, Shao-Bo Chen, Jian-Pin Zhou, Wen Xiao, Han-Gong Fan, Xue-Wei Wu, Gan-Xin Feng and Wei-Xiong He |
From the Department of Gastroenterology, Zhongshan Municipal Bo’ai Hospital, Zhongshan 528403, China (Zhao C, Chen SB, Zhou JP, Xiao W, Fan HG, Wu XW, Feng GX and He WX)
Correspondence: Chao Zhao, MD (Tel: 86-76-8306123ext6073; Fax: 86-76-8306163; Email: zc1963@sohu.com) |
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Abstract Objective: To study the effect of bacterial infection, use of antibiotics, active bleeding at endoscopy, and the severity of liver disease as prognostic factors in hepatic cirrhotic patients during the first 5 days after the episode of esophageal or gastric variceal hemorrhage.
Methods: Seventy-six hepatic cirrhosis patients with esophageal or gastric variceal bleeding were enrolled. Bleeding was managed in a standardized protocol using octreotide and vasopressin in sclerotherapy or band ligation for active bleeding at endoscopy. The screening protocol for bacterial infection consisted of chest radiograph; blood, urine and ascitic fluid cultures; the severity of liver disease shown by Child-Pugh score.
Results: Active bleeding was observed at endoscopy in 40 patients (53%). Failure to control bleeding within 5 days occurred in 36 patients (45%). Empirical antibiotic treatment was used in 53 patients (67%), whereas bacterial infections were documented in 43 patients (57%). Multivariate analysis showed that proven bacterial infection (P<0.01) or antibiotic use (P<0.05) as well as active bleeding at endoscopy (P<0.01) and Child-Pugh score (P<0.01) were independent prognostic factors of failure to control bleeding.
Conclusion: Bacterial infection is associated with fai-lure to control esophageal or gastric variceal bleeding in hepatic cirrhotic patients.
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