Cirrhotics with variceal hemorrhage: The importance of the time interval between admission and the start of analysis for survival and rebleeding rates

Authors

  • Andrew K. Burroughs M.D.,

    Corresponding author
    1. Academic Departments of Medicine and Clinical Epidemiology and General Practice, Royal Free Hospital and School of Medicine, Hampstead, London, NW3 2QG, United Kingdom
    • Academic Department of Medicine, Royal Free Hospital, Pond St., London, NW3 2QG, United Kingdom
    Search for more papers by this author
  • Guerrino Mezzanotte,

    1. Academic Departments of Medicine and Clinical Epidemiology and General Practice, Royal Free Hospital and School of Medicine, Hampstead, London, NW3 2QG, United Kingdom
    Search for more papers by this author
    • Dr. G. Mezzanotte was a visiting fellow from the Istituto di Biometria e Statistica Medica, Università degli Studi di Milano, Milano, Italy.

  • Andrew Phillips,

    1. Academic Departments of Medicine and Clinical Epidemiology and General Practice, Royal Free Hospital and School of Medicine, Hampstead, London, NW3 2QG, United Kingdom
    Search for more papers by this author
  • P. Aiden McCormick,

    1. Academic Departments of Medicine and Clinical Epidemiology and General Practice, Royal Free Hospital and School of Medicine, Hampstead, London, NW3 2QG, United Kingdom
    Search for more papers by this author
  • Neil McIntyre

    1. Academic Departments of Medicine and Clinical Epidemiology and General Practice, Royal Free Hospital and School of Medicine, Hampstead, London, NW3 2QG, United Kingdom
    Search for more papers by this author

Abstract

The importance of variable time of entry for analysis of survival following variceal bleeding has recently been disputed. In a study of 194 cirrhotic patients with bleeding esophageal varices in whom 2-day mortality was 3%, statistically significant differences in both survival and rebleeding rates were obtained by shifting the starting point for analysis of survival by 2 weeks following admission to hospital or by 5 days for the analysis of rebleeding. In addition, the curve of hazard function for death or for failure to control bleeding following admission clearly showed that any change in entry time in a study of variceal bleeding would introduce bias and alter survival or rebleeding rates. Thus, the starting point for analysis following variceal hemorrhage is an important confounding variable when calculating both survival and rebleeding. It should always be taken into account, particularly in clinical trials, which are often performed in centers where patients are referred from other hospitals at different times following bleeding.

Ancillary