TIMING OF THE FIRST VARICEAL HEMORRHAGE IN CIRRHOTIC-PATIENTS - PROSPECTIVE EVALUATION OF DOPPLER FLOWMETRY, ENDOSCOPY AND CLINICAL-PARAMETERS

We followed 87 cirrhotic patients with esophageal varices and without previous hemorrhage for a mean period of 24 mo to prospectively evalua te the occurrence of variceal bleeding within (early) or after (late) 6 mo from entry and the contribution of portal Doppler ultrasound para meters to the prediction of early and late hemorrhage. Clinical, bioch emical, endoscopic and portal Doppler ultrasound parameters were recor ded at entry. Variceal bleeding occurred in 22 patients (25.3%). Nine (40.9%) bled within the first 6 mo. Cox regression analysis identified variceal size, cherry-red spots, serum bilirubin and congestion index of the portal vein (the ratio of portal vein [cross-sectional area] a nd portal blood flow velocity) as the only independent predictors of f irst variceal hemorrhage. Discriminant analysis was used to find the p rognostic index cut off points to identify patients who bled within 6 mo (prognostic group 1) or after g mo (prognostic group 2) or remained free of bleeding (prognostic group 3). The cumulative proportion of p atients correctly classified was 73% in prognostic group 1, 47% in pro gnostic group 2 and more than 80% in prognostic group 3. The addition of Doppler ultrasound flowmetry to clinical, biochemical and endoscopi c parameter only improved the classification of patients with early bl eeding.