OPTIMIZING THE TIME-FRAME FOR THE DEFINITION OF BLEEDING-RELATED DEATH AFTER ACUTE VARICEAL BLEEDING IN CIRRHOSIS

Objective: To identify the best time-frame for defining bleeding-relat ed death after variceal bleeding in patients with cirrhosis. Design: P rospective long-term evaluation of a cohort of 155 patients admitted w ith variceal bleeding. Setting: Eight medical departments in seven hos pitals in north-eastern Italy. Methods: Non-linear regression analysis of a hazard curve for death, and Cox's multiple regression analyses u sing different zero-time points. Results: Cumulative hazard plots gave two slopes, the first corresponding to the risk of death from acute b leeding, the second a baseline risk of death. The first 30 days were o utside the confidence limits of the regression curve for the baseline risk of death. Using Cox's regression analysis, the significant predic tors of overall mortality risk were balanced between factors related t o severity of bleeding and those related to severity of liver disease. If only deaths occurring after 30 days were considered, only predicto rs related to the severity of liver disease were found to be of import ance. Conclusion: Thirty days after bleeding is considered to be a rea sonable time-frame for the definition of bleeding-related death in pat ients with cirrhosis and variceal bleeding.