Original article—liver, pancreas, and biliary tractPredicting Early Mortality After Acute Variceal Hemorrhage Based on Classification and Regression Tree Analysis
Section snippets
Patients
All consecutive episodes of esophageal variceal bleeding in patients with cirrhosis admitted to the Bleeding Unit of our hospital were registered prospectively and included in the study from January 2001 to December 2008. Patients bleeding from gastric varices (n = 26) or portal gastropathy (n = 39) were not included in the study because of their different natural history and prognosis. Baseline and follow-up clinical, biochemical, and radiologic characteristics were recorded. The protocol was
Patient Features and Treatment
During the 8-year period of analysis, 267 consecutive patients with esophageal variceal bleeding admitted to the Bleeding Unit of our hospital were registered. Basal clinical characteristics at admission of patients in the training and test sets are shown in Table 1. Among the 229 patients who underwent an endoscopic treatment, 101 received EST and 128 received EVL. Surgical shunting was performed in 3 patients (2 early rebleeding, 1 for prophylaxis) and 10 patients were treated with
Discussion
In the present study we propose and validate a novel prognostic approach based on CART analysis to assess 6-week mortality in a cohort of patients after an acute esophageal variceal hemorrhage. Clinical outcomes of a large single-center cohort in a day-to-day clinical setting also are described.
The results clearly confirm an improvement in the outcomes of patients with acute variceal bleeding in the past few years compared with historical cohorts. The 24% mortality rate in our study (21%
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2021, European Journal of Internal MedicineCitation Excerpt :Variceal bleeding is a severe cirrhosis-related complication. The 6-week mortality in patients with decompensated cirrhosis is in the range of 10–25%, while mortality in patients with compensated cirrhosis is low [5,72,74,75]. Multiple randomized clinical trials have assessed the clinical efficacy of primary bleeding prophylaxis in patients with high-risk GEV.
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2021, Clinics in Liver DiseaseCitation Excerpt :The prognosis of AVB has improved significantly over the past decades due to better management of the hemorrhage and its associated complications. Mortality, however, still is approximately 15% to 20%.5,6 Moreover, variceal bleeding can trigger other complications of cirrhosis, such as bacterial infections, HE, and hepatorenal syndrome, that deteriorate prognosis further.
Conflicts of interest The authors disclose no conflicts.
Funding Salvador Augustin is a recipient of a fellowship grant from the Institut de Recerca Vall d'Hebron/La Caixa, and is enrolled in the postgraduate program of the Universitat Autònoma de Barcelona; José Altamirano is a recipient of the fellowship grant Estímulo Héctor Orozco Zepeda 2007 from Fundación Mexicana para la Salud (FUNSALUD) AC and Fundación Mexicana para la Salud Hepática (FUNDHEPA) AC, Mexico.
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