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

As identification of patients at risk of bleeding or death is essentia l for prophylaxis, we determined the prognostic influence of various p atient characteristics on the risk of bleeding and death. Fifty-five p atients with cirrhosis and oesophageal varices without previous bleedi ng were included in the study and followed up after an average observa tion 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 univa riate analysis, the following variables showed a significant relation with an increased risk of bleeding or death: high plasma volume (p<0.0 2), high azygos blood flow (p<0.004), elevated hepatic venous pressure gradient (p<0.02), marked prominence of varices (p<0.05), poor nutrit ional status (p<0.0001), decreased clotting factor 2,7,10 (p<0.002), p oor incapacitation index (p<0.004), low serum albumin (p<0.005), incre ased 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), inc reased serum bilirubin (p<0.001), short central circulation time (p<0. 03), low serum albumin (p<0.02), and decreased clotting factor 2, 7, 1 0 (p<0.05) were independently associated with a higher risk. In conclu sion, the results support the prognostic value of metabolic variables as described earlier. The prognostic significance of central circulati on time stresses the importance of the hyperdynamic systemic circulati on in assessing the increased risk of bleeding or death. Assessment of the haemodynamic status in cirrhosis may provide additional prognosti c information and be helpful in the selection of patients for prophyla xis. (C) Journal of Hepatology.