Medscape www.medscape.com

Tables for:
Clinical Significance of Variceal Hemorrhage in Recent Years in Patients With Liver Cirrhosis and Esophageal Varices

[J Gastroenterol Hepatol 19(9):1042-1051, 2004. © 2004 Blackwell Publishing]


Table 1. Univariate Analysis of Clinical, Endoscopic and Biochemical Variables at Time of Inclusion Relative to First Variceal Bleeding and Survival


FactorNo. of patientsNo. of patients who bledP-value*No. of patients who diedP-value*
Sex
  Male22251<0.001850.470
  Female824-26-
Age (years)
  </=51150260.377430.001
  >/=5215429-68-
Heavy alcohol intake
  Absent17220<0.001540.049
  Present13235-57-
Cause of liver cirrhosis
  Alcohol65200.019190.751
  Hepatitis B virus19229-73-
  Hepatitis C virus315-12-
  Other161-7-
Form of varix
  Small16411<0.001490.009
  Large14044-62-
Red color signs
  Absent24526<0.001820.021
  Present5929-29-
Location of varix
  Inferior12814<0.001400.136
  Median14030-56-
  Superior3611-15-
Color of varix
  Blue179350.414680.241
  White12520-43-
Gastric varix
  Absent22831<0.001800.214
  Present7624-31-
Albumin (g/dL)
  </=3.6164340.03477<0.001
  >3.614021-34-
Bilirubin (mg/dL)
  </=1.5150240.068390.003
  >1.515431-72-
Prothrombin time (s)
  </=13.5160340.41247<0.001
  >13.514421-64-
Ascites
  Absent15818<0.00134<0.001
  Present14637-77-
Encephalopathy
  Absent279510.50694<0.001
  Present254-17-
Child grade
  A153230.00328<0.001
  B11321-56-
  C3811-27-
Platelet (103/mm3)
  </=84.5152300.242660.005
  >84.515225-45-
AST (IU/L)
  </=455790.431130.020
  >4524746-98-
DM
  Yes43110.177190.257
  No26144-92-
HTN
  Yes1030.25140.671
  No29452-107-
GB stone
  Yes820.84110.139
  No29653-110-

*Log-rank test. AST, aspartate aminotransferase; DM, diabetes mellitus; GB, gallbladder; HTN, hypertension.


Table 2. Prognostic Factors for First Variceal Bleeding Identified by Stepwise Cox Regression Model, Including 11 Variables at Entry Significant in Univariate Analysis


FactorsHazard ratio (95% confidence interval)P-value
Alcohol ingestion (heavyvsnon-heavy)2.29 (1.32-3.97)0.003
Form of varix (largevssmall)3.26 (1.52-6.98)0.002
Red color sign (presentvsabsent)4.26 (2.31-7.87)<0.001

Table 3. Cumulative Incidences of First Variceal Hemorrhages and Related Deaths in Three Risk Groups Defined by Three Risk Factors for Variceal Bleeding


SubgroupsNo. of patients (bleeding)Incidence of first bleeding (%)Incidence of bleeding related deaths (%)
1 year2 years3 years5 years1 year2 years3 years5 years
Low-risk group205 (14)1.04.48.011.80.01.32.94.2
High-risk group68 (22)12.735.944.944.90.07.612.812.8
Very-high-risk group31 (19)34.957.375.687.83.413.925.825.8

Risk groups were defined by three risk components of a varix larger than F1, positive red color sign and the presence of heavy alcohol consumption. Those with all of three risk components were allocated to the 'very-high-risk group', those with two components to the 'high-risk group', and those with one component or none to the 'low-risk group'.


Table 4. Clinical, Endoscopic and Biochemical Variables at Time of Bleeding in Relation to Mortality Within 6 Weeks of First Variceal Bleeding


FactorNo. of patientsNo. of deaths (%)P-value*
Sex
  Male5112 (24)0.266
  Female42 (50)-
Age (years)
  </=53286 (21)0.485
  54278 (30)-
Heavy drinking
  Absent245 (21)0.489
  Present319 (29)-
Cause of cirrhosis
  Alcohol205 (25)0.364
  Hepatitis B virus297 (24)-
  Hepatitis C virus51 (20)-
  Other11 (100)-
Form of varices
  Small21 (50)0.448
  Large5313 (25)-
Red color signs
  Absent40 (0)0.562
  Present5114 (28)-
Location of varices
  Inferior51 (20)0.889
  Median277 (26)-
  Superior236 (26)-
Color of varices
  Blue247 (29)0.578
  White317 (23)-
Gastric varices
  Absent278 (30)0.485
  Present286 (21)-
Albumin (g/dL)
  </=3.125100.032
  >3.1304-
Bilirubin (mg/dL)
  </=1.8261<0.001
  >1.82913-
Prothrombin time (s)
  </=13.72860.547
  >13.7278-
Ascites
  Absent212 (10)0.054
  Present3412 (35)-
Encephalopathy
  Absent437 (16)0.003
  Present127 (58)-
Child grade
  A160 (0)<0.001
  B193 (16)-
  C2011 (55)-
Platelet (103/mm3)
  </=772811 (30)0.029
  >77273 (9)-
AST (IU/L)
  </=78294 (14)0.061
  >782610 (38)-
PVT
  Absent5110 (20)0.003
  Present44 (100)-

*Comparison of proportions was performed using the chi-squared test or the Fisher's exact test when the number in a cell was </=5.
Tumor thrombus in main portal vein. AST, aspartate aminotransferase; PVT, portal vein thrombus.


Table 5. Causes of Death in Patients With Liver Cirrhosis and Esophageal Varix


GroupCause of death (%)
Hepatic failureHepatocellular carcinomaVariceal bleedingHepatorenal syndromeInfectionOtherTotal
Cause of liver cirrhosis
  Alcohol10 (43)1 (4)6 (26)2 (9)2 (9)2 (9)23 (100)
  Non-alcohol40 (45)23 (26)11 (13)6 (7)3 (3)5 (6)88 (100)
Risk of variceal bleeding
  Low risk36 (58)11 (18)5 (8)3 (5)2 (3)5 (8)62 (100)
  High or more risk14 (29)13 (27)12 (24)5 (10)3 (6)2 (4)49 (100)
Entire group50 (45)24 (22)17 (15)8 (7)5 (5)7 (6)111 (100)

Table 6. Univariate Analysis of Variceal Bleeding and Hepatocellular Carcinoma (HCC) in Relation to Survival


FactorNo. of patients (deaths)Cumulative survival rates (%)P-value
1 year2 years3 years4 years5 years
Variceal bleeding
  Absent249 (72)93.583.371.764.456.80.013
  Present55 (39)94.678.254.642.933.0-
HCC
  Absent264 (84)93.181.870.362.454.60.031
  Present40 (27)97.584.954.140.528.3-

Table 7. Prognostic Factors for Survival Identified Using Stepwise Cox-Oakes' Regression Model, Including Variceal Bleeding, Hepatocellular Carcinoma (HCC) and 12 Variables at Entry Significant in Univariate Analysis


Group and factorHazard ratio (95% CI)P-value
Entire patient group
  Age (years)1.02 (1.00-1.04)0.038
  Albumin (g/dL)0.40 (0.27-0.58)<0.001
  Ascites (presentvsabsent)1.56 (1.00-2.44)0.049
  Encephalopathy (presentvsabsent)1.84 (1.21-2.81)0.005
  Child-Pugh score1.33 (1.22-1.45)<0.001
  Platelet (103/mm3)0.93 (0.88-0.99)0.012
  HCC (presentvsabsent)2.64 (1.62-4.31)<0.001
  Variceal bleeding (presentvsabsent)3.87 (2.22-6.73)<0.001
  Time after variceal bleeding (months)0.97 (0.95-0.99)0.003
Alcoholic cirrhosis
  Encephalopathy (presentvsabsent)8.61 (2.60-28.46)<0.001
  Variceal bleeding (presentvsabsent)26.03 (7.73-87.68)<0.001
  Time after variceal bleeding (months)0.94 (0.89-0.98)0.009
Non-alcoholic cirrhosis
  Age (years)1.03 (1.00-1.05)0.007
  Albumin (g/dL)0.21 (0.14-0.31)<0.001
  HCC (presentvsabsent)2.90 (1.75-4.83)<0.001
  Variceal bleeding (presentvsabsent)3.20 (1.61-6.36)<0.001
  Time after variceal bleeding (months)0.97 (0.95-0.99)0.040
Child-Pugh grade A
  HCC (presentvsabsent)4.63 (1.76-9.03)<0.001
  Form of varix (largevssmall)2.54 (1.13-5.70)0.020
Child-Pugh grade B
  HCC (presentvsabsent)3.22 (1.66-6.25)<0.001
  Variceal bleeding (presentvsabsent)5.70 (2.64-12.33)<0.001
  Time after variceal bleeding (months)0.94 (0.90-0.98)0.003
Child-Pugh grade C
  Age (years)1.04 (1.00-1.09)0.038

Child-Pugh score and its five component variables were analyzed separately on the basis of two Cox-Oakes' models. CI, confidence interval.