VARICEAL PRESSURE IS A FACTOR PREDICTING THE RISK OF A FIRST VARICEALBLEEDING - A PROSPECTIVE COHORT STUDY IN CIRRHOTIC-PATIENTS

Predictive criteria for a first variceal hemorrhage lack substantial a ccuracy. Cross-sectional studies suggest a close relationship between variceal pressure (VP) and the occurrence of variceal bleeding. In the present prospective cohort study, the significance of VP measurement for prediction of a first variceal bleed was assessed. Eighty-seven pa tients with cirrhosis and large esophageal varices who had never devel oped variceal bleeding were followed for 12 months. The endpoint of th e study was the presentation or not of a variceal hemorrhage. Thirty-f our patients (39%) were in Child's class A, 37 in class B (43%), and 1 6 in class C (18%). The median interval between endoscopic diagnosis o f varices and the beginning of the study was 15 months. Twenty-eight p atients (32%) developed a variceal hemorrhage with a bleeding-related mortality of 18% (n = 5). The 1-year mortality overall was 16% (n = 14 ). Variables predictive of a first bleed identified by Cox proportiona l hazards regression model were: the level of VP, the North Italian En doscopic Club (NIEC) score, and the interval between the diagnosis of varices and the start of the study. By adding VP to NIEC, a significan t gain in prognostic accuracy was obtained (P = .003). In conclusion, the present study provides evidence that the level of VP is a major pr edictive factor for variceal hemorrhage, and that it provides further prognostic information in addition to the NIEC index.