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
ISSN: 15908658





DIGESTIVE AND LIVER DISEASE
Editorial
ELSEVIER SCIENCE INC, STE 800, 230 PARK AVE, NEW YORK, NY 10169 USA, Italia
Tipo de documento: Article
Volumen: 52 Número: 9
Páginas: 1017-1025
WOS Id: 000565205600017
ID de PubMed: 32653417

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