Tsung-Hsing Hung1,2, Chih-Wei Tseng1,2, Chih-Chun Tsai3, Chorng-Jang Lay2,4, Chen-Chi Tsai2,4. 1. Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan. 2. School of Medicine, Tzu Chi University, Hualien, Taiwan. 3. Department of Mathematics, Tamkang University, Tamsui, Taiwan. 4. Division of Infectious Disease, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.
Abstract
INTRODUCTION: Large, recent population-based data for evaluating the predictors of oesophageal variceal bleeding (OVB) among cirrhotic patients is still lacking. This study aimed to determine the cumulative incidence of OVB among cirrhotic patients and identify the predictors of OVB occurrence. METHODS: Patient information on 38,172 cirrhotic patients without a history of OVB, who were discharged between 1 January 2007 and 31 December 2007, was obtained from the Taiwan National Health Insurance Database for this study. All patients were followed up for three years. Death was the competing risk when calculating the cumulative incidences and hazard ratios (HRs) of OVB. RESULTS: OVB was present in 2,609 patients (OVB group) and absent in 35,563 patients (non-OVB group) at hospitalisation. During the three-year follow-up period, the cumulative incidence of OVB was 44.5% and 11.3% in the OVB and non-OVB group, respectively (p < 0.001). Modified Cox regression analysis showed that the HR of OVB history was 4.42 for OVB occurrence (95% confidence interval [CI] 4.13-4.74). Other predictors for OVB occurrence included hepatocellular carcinoma (HR 1.16, 95% CI 1.09-1.24), young age (HR 0.98, 95% CI 0.98-0.98), ascites (HR 1.46, 95% CI 1.37-1.56), alcohol-related disorders (HR 1.20, 95% CI 1.12-1.28), peptic ulcer bleeding (HR 1.26, 95% CI 1.13-1.41) and diabetes mellitus (HR 1.14, 95% CI 1.06-1.23). CONCLUSION: Cirrhotic patients have a fourfold increased risk of future OVB following the first incidence of OVB.
INTRODUCTION: Large, recent population-based data for evaluating the predictors of oesophageal variceal bleeding (OVB) among cirrhoticpatients is still lacking. This study aimed to determine the cumulative incidence of OVB among cirrhoticpatients and identify the predictors of OVB occurrence. METHODS:Patient information on 38,172 cirrhoticpatients without a history of OVB, who were discharged between 1 January 2007 and 31 December 2007, was obtained from the Taiwan National Health Insurance Database for this study. All patients were followed up for three years. Death was the competing risk when calculating the cumulative incidences and hazard ratios (HRs) of OVB. RESULTS: OVB was present in 2,609 patients (OVB group) and absent in 35,563 patients (non-OVB group) at hospitalisation. During the three-year follow-up period, the cumulative incidence of OVB was 44.5% and 11.3% in the OVB and non-OVB group, respectively (p < 0.001). Modified Cox regression analysis showed that the HR of OVB history was 4.42 for OVB occurrence (95% confidence interval [CI] 4.13-4.74). Other predictors for OVB occurrence included hepatocellular carcinoma (HR 1.16, 95% CI 1.09-1.24), young age (HR 0.98, 95% CI 0.98-0.98), ascites (HR 1.46, 95% CI 1.37-1.56), alcohol-related disorders (HR 1.20, 95% CI 1.12-1.28), peptic ulcer bleeding (HR 1.26, 95% CI 1.13-1.41) and diabetes mellitus (HR 1.14, 95% CI 1.06-1.23). CONCLUSION:Cirrhoticpatients have a fourfold increased risk of future OVB following the first incidence of OVB.
Authors: Lucio Amitrano; Maria Anna Guardascione; Francesco Manguso; Raffaele Bennato; Antonio Bove; Claudio DeNucci; Giovanni Lombardi; Rossana Martino; Antonella Menchise; Luigi Orsini; Salvatore Picascia; Elisabetta Riccio Journal: Am J Gastroenterol Date: 2012-09-25 Impact factor: 10.864