PROGNOSTIC VARIABLES IN PATIENTS WITH CIRRHOSIS AND ESOPHAGEAL-VARICES WITHOUT PRIOR BLEEDING

As identification of patients at risk of bleeding or death is essential for prophylaxis, we determined the prognostic influence of various patient characteristics on the risk of bleeding and death. Fifty-five patients with cirrhosis and oesophageal varices without previous bleeding were included in the study and followed up after an average observation period of 446 days (range: 5-1211 days). A total of 55 clinical, biochemical, haemodynamic, and endoscopic variables were classified as systemic haemodynamic, portal haemodynamic, or metabolic. Using univariate analysis, the following variables showed a significant relation with an increased risk of bleeding or death: high plasma volume (p<0.02), high azygos blood flow (p<0.004), elevated hepatic venous pressure gradient (p<0.02), marked prominence of varices (p<0.05), poor nutritional status (p<0.0001), decreased clotting factor 2,7,10 (p<0.002), poor incapacitation index (p<0.004), low serum albumin (p<0.005), increased serum bilirubin (p=0.05), elevated alkaline phosphatases (p<0.02), low arterial oxygen saturation (p=0.02), and encephalopathy (p<0.007). In a Cox regression model, poor nutritional status (p<0.00005), increased serum bilirubin (p<0.001), short central circulation time (p<0.03), low serum albumin (p<0.02), and decreased clotting factor 2, 7, 10 (p<0.05) were independently associated with a higher risk. In conclusion, the results support the prognostic value of metabolic variables as described earlier. The prognostic significance of central circulation time stresses the importance of the hyperdynamic systemic circulation in assessing the increased risk of bleeding or death. Assessment of the haemodynamic status in cirrhosis may provide additional prognostic information and be helpful in the selection of patients for prophylaxis. (C) Journal of Hepatology.