Sirotik Varis Kanamalarında Tekrar Kanama Belirleyicileri

Abstract

Aim: Cirrhotic patients with acute variceal bleeding are characterized by a high mortality and rebleeding rate. The aim of this study was to explore predictors of rebleeding in cirrhotic patients. Methods: Cirrhotic patients who were admitted to the hospital were retrospectively analyzed. Rebleeding was defined as a new onset of hematemesis, hematochezia or melena after endoscopic therapy, and a period of stable vital signs and hemoglobin. Medical records as laboratory data include hemoglobin and platelet level, prothrombin time, creatinine, bilirubin, albumin level, vital signs, need of blood transfusions, comorbidities, medications, clinical findings as presence of ascites and hepatic encephalopathy, and endoscopic findings of varices were recorded and entered a computer-based database. Child-Pugh stage was also calculated and recorded. Results: 20 patients (21%) with recurrent hemorrhage after control of the variceal bleeding during the six-week follow-up period were included in this study. The level of albumin and hemoglobin in the rebleeding group were significantly lower than those in non-rebleeding group. The mean level of albumin was 2.45 mg/dL (vs. 3.05 mg/dL, p=0.01) and hemoglobin was 7.96 g/dL (vs. 9.92 g/dL, p=0.001). Ascites was seen to be significantly higher in the rebleeding group (50% vs. 14%, p=0.002). After multivariate regression analysis, we found that lower hemoglobin level and Child-Pugh grade were the only independent significant predictors for variceal rebleeding. Conclusion: Since factors such as the Child-Pugh grade, hypoalbuminemia and presence of ascites are associated with portal hypertension and hepatic failure, we found that lower hemoglobin level and Child-Pugh grade were the only independent significant predictors for variceal rebleeding.