PREDICTIVE FACTORS OF VARICEAL BLEEDING CONTROL BY EMERGENCY SCLEROTHERAPY

Objectives. - Acute bleeding from esophageal varices is a major compli cation of cirrhosis. Despite the large number of published studies no predictive factors of control of bleeding have been identified. We ass essed the clinical and biological factors predictive of bleeding contr ol within the first 2 weeks after a bleeding episode in a homogeneous group of patients enrolled in a large multicenter trial, who underwent a standardized emergency sclerotherapy session.Methods. - 101 patient s with cirrhosis were enrolled. All had endoscopy-proven variceal blee ding, and the interval between hematemesis or melena and emergency scl erotherapy was always less than 24 hours. A second sclerotherapy sessi on and other methods for the prevention of rebleeding were allowed aft er 5 days.Results. - Treatment failed in 16 patients after 24 hours an d in a total of 33 patients after 15 days. Three of the 17 variables i ncluded in multivariate logistic analysis were associated with failure at 24 hours : encephalopathy (P = 0.006, OR = 4.0), blood transfusion prior to sclerotherapy (P = 0.012, OR = 6.2) and previous propranolol therapy (P = 0.022, OR = 4.6). Two variables were associated with fai lure between 24 hours and day 15 in patients successfully controlled a fter 24 hours : an interval between the onset of bleeding and scleroth erapy of less than 12 hours (P = 0.010) and blood transfusion (P = 0.0 18). After 15 days, three variables were associated with failure in a multivariate Cox model : encephalopathy (P = 0.0025, OR = 2.3), time t o sclerotherapy (P = 0.022, OR 2.3) and blood transfusion before scler otherapy (P = 0.0005, OR = 4.0). Conclusion. - Encephalopathy, the sev erity of bleeding, assessed in terms of transfusion requirements, and the time between clinically overt bleeding and sclerotherapy are the m ain predictive factors of failure of the control of bleeding after eme rgency sclerotherapy for acute bleeding from esophageal varices.