Influencing factors for rebleeding after endoscopic therapy in patients with liver cirrhosis receiving secondary prevention of gastroesophageal varices
Objective To investigate the influencing factors for rebleeding after endoscopic therapy and the effect of the number of sequential treatment sessions on postoperative rebleeding in patients with liver cirrhosis receiving secondary prevention of gastroesophageal varices(GOV).Methods A total of 1 717 patients with liver cirrhosis who received secondary prevention of GOV and attended The 960th Hospital of the PLA Joint Logistice Support Force from January 2017 to December 2021 were enrolled,and according to the presence or absence of bleeding after endoscopic therapy,they were divided into non-bleeding group and rebleeding group.The influencing factors for rebleeding were analyzed,as well as the association between the number of endoscopic treatment sessions and rebleeding.The chi-square test was used for comparison of categorical data between groups;the independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between the two groups;the Kruskal-Wallis H test was used for comparison bertween multiple groups,and the Wilcoxon test was used for further comparison between two groups.The Cox regression model was used to investigate the influencing factors for rebleeding,and the Kaplan-Meier method was used to plot survival curves,while the Log-rank test was used for comparison between groups.Results Of all patients,286(16.7%)experienced rebleeding after endoscopic therapy,and 1 431(83.3%)did not experience bleeding.There were significant differences between the two groups in history of smoking and drinking,etiology of liver cirrhosis,hemoglobin(Hb),prothrombin time(PT),prothrombin activity(PTA),international normalized ratio(INR),albumin(Alb),fasting blood glucose,blood urea nitrogen,Child-Pugh class,aspartate aminotransferase-to-platelet ratio index(APRI)score,albumin-bilirubin(ALBI)score,use of non-selective beta-blocker(NSBB)before surgery,treatment modality,type of varices,and maximal varicose vein diameter(all P<0.05).The univariate Cox regression analysis showed that in the patients with liver cirrhosis who received secondary prevention of GOV,rebleeding was associated with history of smoking and drinking,etiology of liver cirrhosis,use of NSBB before surgery,treatment modality,maximal varicose vein diameter,Hb,platelet count,PT,PTA,INR,Alb,total bilirubin(TBil),alkaline phosphatase(ALP),gamma-glutamyl transpeptidase,blood glucose,Child-Pugh class,and ALBI score(all P<0.05).The multivariate Cox regression analysis showed that Hb(hazard ratio[HR]=0.989,95%confidence interval[CI]:0.983-0.994,P<0.001),TBil(HR=1.020,95%CI:1.006-1.034,P=0.005),Alb(HR=0.868,95%CI:0.758-0.994,P=0.041),treatment modality(sclerosing agent:HR=2.158,95%CI:1.342-3.470,P=0.002;tissue adhesive:HR=2.709,95%CI:1.343-5.462,P=0.005;ligation+sclerosing agent:HR=3.181,95%CI:1.522-6.645,P=0.002;sclerosing agent+tissue adhesive:HR=1.851,95%CI:1.100-3.113,P=0.020),ALP(HR=1.003,95%CI:1.001-1.004,P=0.002),and maximal varicose vein diameter(HR=1.346,95%CI:1.119-1.618,P=0.002)were independent influencing factors for rebleeding after endoscopic therapy.Comparison of rebleeding rate after different numbers of sequential treatment sessions showed that the patients treated for three sessions had a significantly lower rebleeding rate than those treated for one or two sessions(χ2=8.643 and 5.277,P=0.003 and 0.022).The survival analysis showed that with the increase in the number of treatment sessions,there was a significantly longer interval between rebleeding(P=0.006)and a significantly lower mortality rate(P<0.001).Conclusion The levels of TBil,ALP,Hb,and Alb on admission,endoscopic treatment modality,and maximal varicose vein diameter were the main predictive factors for rebleeding after endoscopic therapy for GOV in liver cirrhosis,and such predictive factors should be closely monitored in clinical practice.Regular endoscopic therapy can reduce the rebleeding and mortality rates of patients with liver cirrhosis and GOV and prolonmg the interval between rebleeding.
Liver CirrhosisEsophageal and Gastric VaricesEndoscopyRe-bleeding
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