Early rebleeding increases mortality of variecal bleeders on secondary prophylaxis with beta-blockers and ligation
Por:
Ardevol, A, Alvarado-Tapias, E, Garcia-Guix, M, Brujats, A, Gonzalez, L, Hernandez-Gea, V, Aracil, C, Pavel, O, Cuyas, B, Graupera, I, Colomo, A, Poca, M, Torras, X, Concepcion, M, Villanueva, C
Publicada:
1 sep 2020
Resumen:
Background/aims: Despite secondary-prophylaxis with beta-blockers and endoscopic-variceal-ligation rebleeding is frequent, particularly within the first-6-weeks. Early-rebleeding may have greater impact on death-risk than late rebleeding, which may affect therapy. We assessed whether the influence of rebleeding on long-term survival of patients on secondary-prophylaxis is greater in patients with early-rebleeding.
Methods: 369 patients with cirrhosis were consecutively included once recovered from first variceal-bleeding. The impact of rebleeding on survival was investigated according to whether it occurred within 6-weeks (early-rebleeding) or later (late-rebleeding).
Results: During 46-months of follow-up (IQR: 14-61), 45 patients (12%) had early-rebleeding, 74(20%) had late-rebleeding and 250(68%) had not rebleeding. Mortality risk was higher in early-rebleeding group vs. late-rebleeding (HR = 0.476, 95%CI = 0.318-0.712, p < 0.001) and was similar in late-rebleeding group vs. no-rebleeding (HR = 0.902, 95%CI = 0.749-1.086, p = 0.271). Adjusting for baseline risk-factors, early-rebleeding was independently associated with mortality-risk (HR = 1.58, 95%CI = 1.02-2.45; p = 0.04). Child-Pugh&MELD scores improved at 3rd-4th-week only in patients without early-rebleeding (p < 0.05). Presence of ascites or encephalopathy, MELD-score>12 and HVPG>20 mmHg identified patients at risk of early-rebleeding.
Conclusions: Patients with early-rebleeding have higher risk of death than patients without rebleeding and even than those rebleeding later. Our results suggest that patients at risk of early rebleeding might benefit from preemptive therapies such as early-TIPS. (C) 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
Filiaciones:
Ardevol, A:
Hosp Santa Creu & Sant Pau, Dept Gastroenterol, Mas Casanovas 90, Barcelona 08041, Spain
Hosp Santa Creu & Sant Pau, Inst Recerca, Barcelona, Spain
Univ Autonoma Barcelona, Barcelona, Spain
Alvarado-Tapias, E:
Hosp Santa Creu & Sant Pau, Dept Gastroenterol, Mas Casanovas 90, Barcelona 08041, Spain
Hosp Santa Creu & Sant Pau, Inst Recerca, Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Garcia-Guix, M:
Hosp Santa Creu & Sant Pau, Dept Gastroenterol, Mas Casanovas 90, Barcelona 08041, Spain
Hosp Santa Creu & Sant Pau, Inst Recerca, Barcelona, Spain
Brujats, A:
Hosp Santa Creu & Sant Pau, Dept Gastroenterol, Mas Casanovas 90, Barcelona 08041, Spain
Hosp Santa Creu & Sant Pau, Inst Recerca, Barcelona, Spain
Gonzalez, L:
Hosp Santa Creu & Sant Pau, Dept Gastroenterol, Mas Casanovas 90, Barcelona 08041, Spain
Hosp Santa Creu & Sant Pau, Inst Recerca, Barcelona, Spain
Hernandez-Gea, V:
Hosp Santa Creu & Sant Pau, Dept Gastroenterol, Mas Casanovas 90, Barcelona 08041, Spain
Hosp Santa Creu & Sant Pau, Inst Recerca, Barcelona, Spain
Univ Barcelona, Hosp Clin, Ctr Invest Biomed Red Enfermedades Hepat & Digest, IDIBAPS,Barcelona Hepat Hemodynam Lab,Liver Unit, Barcelona, Spain
Aracil, C:
IRBLleida, Hosp Arnau Vilanova, Lleida, Spain
Pavel, O:
Hosp Santa Creu & Sant Pau, Dept Gastroenterol, Mas Casanovas 90, Barcelona 08041, Spain
Hosp Santa Creu & Sant Pau, Inst Recerca, Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Cuyas, B:
Hosp Santa Creu & Sant Pau, Dept Gastroenterol, Mas Casanovas 90, Barcelona 08041, Spain
Hosp Santa Creu & Sant Pau, Inst Recerca, Barcelona, Spain
Graupera, I:
Hosp Santa Creu & Sant Pau, Dept Gastroenterol, Mas Casanovas 90, Barcelona 08041, Spain
Hosp Santa Creu & Sant Pau, Inst Recerca, Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Colomo, A:
Hosp Santa Creu & Sant Pau, Dept Gastroenterol, Mas Casanovas 90, Barcelona 08041, Spain
Hosp Santa Creu & Sant Pau, Inst Recerca, Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Poca, M:
Hosp Santa Creu & Sant Pau, Dept Gastroenterol, Mas Casanovas 90, Barcelona 08041, Spain
Hosp Santa Creu & Sant Pau, Inst Recerca, Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Torras, X:
Hosp Santa Creu & Sant Pau, Dept Gastroenterol, Mas Casanovas 90, Barcelona 08041, Spain
Hosp Santa Creu & Sant Pau, Inst Recerca, Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Univ Autonoma Barcelona, Barcelona, Spain
Concepcion, M:
Hosp Santa Creu & Sant Pau, Dept Gastroenterol, Mas Casanovas 90, Barcelona 08041, Spain
Hosp Santa Creu & Sant Pau, Inst Recerca, Barcelona, Spain
Villanueva, C:
Hosp Santa Creu & Sant Pau, Dept Gastroenterol, Mas Casanovas 90, Barcelona 08041, Spain
Hosp Santa Creu & Sant Pau, Inst Recerca, Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Univ Autonoma Barcelona, Barcelona, Spain
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