Predictors of in-hospital mortality after acute variceal bleeding in patients with hepatocellular carcinoma and concurrent main portal vein thrombosis
Journal
Journal of Gastroenterology and Hepatology (Australia)
Journal Volume
29
Journal Issue
2
Pages
344-351
Date Issued
2014
Author(s)
Abstract
Background and Aim: Risk factors for acute variceal bleeding in patients with hepatocellular carcinoma (HCC) and concurrent main portal vein thrombosis (PVT) remain unclear. We aimed to determine risk factors of in-hospital mortality after acute variceal bleeding for HCC patients with concurrent main PVT. Methods: We conducted a retrospective analysis of 102 HCC patients (83% men and 17% women) with concurrent main PVT and acute variceal bleeding. All patients received emergent endoscopy to define the bleeding source. Multivariable Cox proportional hazard regression analysis consisting of clinical, laboratory, and endoscopic parameters was performed to identify predictive factors for intrahospital mortality. Results: Twenty-eight (27.5%) patients died within admission. The median survival of all patients was 56 days. Multivariable Cox proportional hazard regression analyses revealed Child-Pugh score (adjusted hazard ratio [aHR]: 1.29 for each point 95% confidence interval [CI]: 1.11-1.50), active bleeding on index endoscopy (aHR: 7.50; 95% CI: 3.05-18.4), esophageal varices as the bleeder (compared with gastric varices, aHR: 14.3; 95% CI: 3.12-66.1), failure to control bleeding (aHR: 38.0; 95% CI: 7.44-194), and serum creatinine (aHR: 1.28 for each increase of 1mg/dL; 95% CI: 1.09-1.50) independently predicted in-hospital mortality. Conclusions: Hepatic reserve, active bleeding on index endoscopy, failure to control bleeding, esophageal varices as the bleeder when compared with gastric varices, and renal function were independent predictive factors for in-hospital mortality in HCC patients with acute variceal bleeding and concurrent main PVT. ? 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.
SDGs
Other Subjects
creatinine; enbucrilate; iodinated poppyseed oil; somatostatin; terlipressin; adult; Article; cancer patient; Child Pugh score; confidence interval; conservative treatment; controlled study; creatinine blood level; disease association; disease control; endoscopic therapy; esophagogastroduodenoscopy; esophagus varices; esophagus varices bleeding; female; gastrointestinal endoscopy; hazard ratio; hospital admission; human; laboratory test; liver cell carcinoma; major clinical study; male; medical record review; middle aged; mortality; multivariate analysis; overall survival; portal vein thrombosis; predictor variable; priority journal; proportional hazards model; radiological parameters; rectum hemorrhage; risk factor; serum; stomach varices; stomach varices bleeding; acute disease; acute variceal bleeding; article; endoscopic injection of tissue adhesives; endoscopic variceal ligation; esophagus varices; forecasting; gastrointestinal hemorrhage; incidence; liver cell carcinoma; liver tumor; mortality; portal vein; portal vein thrombosis; retrospective study; vein thrombosis; acute variceal bleeding; endoscopic injection of tissue adhesives; endoscopic variceal ligation; hepatocellular carcinoma; portal vein thrombosis; Acute Disease; Adult; Carcinoma, Hepatocellular; Endoscopy, Gastrointestinal; Esophageal and Gastric Varices; Female; Forecasting; Gastrointestinal Hemorrhage; Hospital Mortality; Humans; Incidence; Liver Neoplasms; Male; Middle Aged; Portal Vein; Retrospective Studies; Risk Factors; Venous Thrombosis
Publisher
Blackwell Publishing
Type
journal article