Predictors of in-hospital mortality after acute variceal bleeding in patients with hepatocellular carcinoma and concurrent main portal vein thrombosis.
J Gastroenterol Hepatol. 2013 Jul 22;
Authors: Han ML, Chen CC, Kuo SH, Hsu WF, Liou JM, Wu MS, Wang HP
BACKGROUND: 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.
PATIENTS AND METHODS: We conducted a retrospective analysis of 102 HCC patients (83% male and 17% female) 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 intra-hospital 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 1 mg/dL; 95% CI: 1.09-1.50) independently predicted in-hospital mortality.
CONCLUSION: 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.
PMID: 23870023 [PubMed - as supplied by publisher]