Risk factors for early rebleeding after esophageal variceal ligation in patients with liver cirrhosis

Abstract

Objective: To investigate the risk factors for early rebleeding after esophageal variceal ligation (EVL) through a multicenter retrospective study. Methods: A total of 3289 patients who were hospitalized and underwent EVL in 17 upper second-class hospitals or hospitals of higher classes from January 1999 to May 2015 were collected and screened according to the exclusion criteria. A total of 2531 patients were screened out, and a retrospective analysis was performed for their clinical data including age, sex, endoscopic findings, and results of laboratory examination (liver function, biochemical results, routine blood test, and coagulation function) to collect related data. According to the presence or absence of rebleeding within 1 month after EVL, the patients were divided into rebleeding group and non-rebleeding group. SPSS22.0 software was used for independent t-test and one-way analysis of variance, and P < 0.05 was considered statistically significant. Results: In the 2531 patients who underwent EVL, the rate of early rebleeding after EVL was 6.6%, and the mortality rate was 12.0%. The results showed that sex (P = 0.014), number of veins with varices (P = 0.203), prothrombin time (P = 0.001), prothrombin activity (P = 0.014), albumin (P = 0), total bilirubin (P = 0.011), aspartate aminotransferase (P = 0.004), white blood cell count (P = 0.342), hepatic encephalopathy (P = 0.021), ascites (P = 0.027), Child-Pugh class (P = 0), Child-Pugh score (P = 0), glue injection for gastric varices (P = 0.521), gastric varices (P = 0.32), shunt (P = 0.174), number of ligation points (P = 0.001), number of ligation times (P = 0.024), number of times of hematemesis before treatment (P = 0), number of times of tarry stool (P = 0.008), and volume of blood in hematemesis before treatment (P = 0) were risk factors for early rebleeding after EVL. The regression analysis showed that male sex, a Child-Pugh score of >7.2, and volume of blood in hematemesis before treatment were independent risk factors for early rebleeding after EVL, while an albumin concentration of > 31.5 g/L was the protective factor. Conclusion: EVL has a good therapeutic effect in esophageal variceal rebleeding. Among all the factors analyzed, male sex, a Child-Pugh score of > 7.2, and volume of blood in hematemesis before treatment are independent risk factors for early rebleeding after EVL, and an albumin concentration of > 31.5 g/L is a protective factor.