Prognostic factors associated with mortality in patients with gastric fundal variceal bleeding

Abstract

AIMTo determine the prognostic factors associated with mortality in patients with gastric fundal variceal (GFV) bleeding.METHODSIn total, 42 patients were endoscopically diagnosed with GFV bleeding from January 2000 to March 2014. We retrospectively reviewed the patients' medical records and assessed their history, etiology of liver cirrhosis, disease conditions, treatment options for GFV bleeding, medications administered before and after onset of GFV bleeding, blood test results (hemoglobin, albumin, and bilirubin concentrations), and imaging results (including computed tomography and abdominal ultrasonography). We also assessed the prognostic factors associated with short-term mortality (up to 90 d) and long-term mortality in all patients.RESULTSMultivariate analysis showed that prophylactic administration of antibiotics was an independent prognostic factor associated with decreases in short-term mortality (OR = 0.08, 95%CI: 0.01-0.52) and long-term mortality (OR = 0.27, 95%CI: 0.08-0.91) in patients with GFV bleeding. In contrast, concurrent hepatocellular carcinoma (HCC) and regular use of proton pump inhibitors (PPI) were independent prognostic factors associated with increases in short-term mortality (HCC: OR = 15.4, 95%CI: 2.08-114.75; PPI: OR = 12.76, 95%CI: 2.13-76.52) and long-term mortality (HCC: OR = 7.89, 95%CI: 1.98-31.58; PPI: OR = 10.91, 95%CI: 2.86-41.65) in patients with GFV bleeding. The long-term overall survival rate was significantly lower in patients who regularly used PPI than in those who did not use PPI (P = 0.0074).CONCLUSIONAdministration of antibiotics is associated with decreased short- and long-term mortality, while concurrent HCC and regular PPI administration are associated with increased short- and long-term mortality.

Clinical significance of isolated gastric varices in liver cirrhotic patients: A single‐referral‐centre retrospective cohort study

“…On the basis of pathogenesis, GOVs and IGVs tend to have more blood supply than OVs owing to the complexity of potential vascular anastomosis involving the left gastric vein, azygos vein, and inferior phrenic vein. Therefore, GV rupture can cause massive bleeding and might lead to a high mortality rate because of difficulty in controlling bleeding . The other main issue in clinical practice with respect to GVs is that they do not correlate well with the measurement of hepatic vein pressure gradient (HVPG), which is usually considered as the gold‐standard method for confirming and monitoring clinically significant portal hypertension during treatment.…”

Prognostic Factors Associated with Mortality in Cirrhotic Patients with Bleeding Varices

“…No significant differences were recorded as regards proton pump inhibitor (PPI) infusion. This finding was in disagreement with Komori et al, 14 who found an association between regular PPI treatment before and after the onset of variceal bleeds and increments in short as well as long-term mortalities. This could be explained by the increased risk of infections such as bacterial infections in general and spontaneous bacterial peritonitis following regular PPI use.…”

Clinical mortality risk factors of variceal upper gastrointestinal bleeding in a Malagasy surgical intensive care unit

“…The clinical risk factors for mortality found by other authors are ascites, jaundice, hepatic encephalopathy, alcoholic liver disease and shock (without being constant) [ [6] , [7] , [8] ]. Komori et al [ 9 ] found that the “classical” factors of mortality were not associated with the mortality from VUGIB; except hepatocarcinoma (increases mortality by 5.17 [ p = 0.0209]). Jaundice and hepatic encephalopathy were not correlated with mortality in our study.…”