Prognostic criteria of variceal bleeding in patients with portal hypertension
Aim. To determine prognostic criteria of variceal bleeding in patients with portal hypertension. Material and methods. There were 53 patients with portal hypertension and the threat of variceal bleeding from the esophagus and stomach without previous hemorrhage. Univariate and multivariate analysis was applied to determine prognostic criteria of the first bleeding. Patients with esophageal and gastroesophageal varices were analyzed separately. The following prognostic criteria were considered: dimensions of the veins, vasculopathy and gastropathy, liver function. Results. Incidence of hemorrhage was 72.7% in patients with esophageal varices grade 3, in case of vasculopathy - 80%. Child-Pugh class A was followed by incidence of hemorrhage near 12.5%, class B - 44%, C - 100%. MELD score ≤ 9 was associated with bleeding rate 28.6%, 10-19 - 39.3%, over 20 scores - 100%. According to multivariate analysis consisting of Child-Pugh classification, in patients with < 11 scores 1-year incidence of bleeding was 13.3%, in case of MELD classification - 16.7%. The same values in patients with 11-16 scores were 77.8% and 31.3%, respectively. Analysis including both classifications (overall score over 16) was associated with incidence of hemorrhage up to 100%. Gastroesophageal varices grade 3 were associated with the risk of hemorrhage near 44.4% within 12 months, in case of vasculopathy - 60%, gastropathy - 37.5%. Incidence of hemorrhage in patients with Child- Pugh class A was 12.5%, class B - 44%, class C - 100%. In patients with MELD score ≤ 9 bleeding rate was 28.6%, 10-19 scores - 39.3%, over 20 scores - 100%. According to multivariate analysis consisting of Child-Pugh classification, patients with gastroesophageal varices and less than 11 scores have the probability of hemorrhage near 15.4% within 12 months, in case of MELD score - 23%. The same values were 55.6% and 50%, respectively in case of 11-18 scores. In patients with more than 18 scores incidence of hemorrhage was 75% considering Child-Pugh classification and 100% for the MELD classification. Conclusion. The group of patients with threat of bleeding within 12 months was determined that makes possible a differentiated approach to patients who for need primary prevention of bleeding.