High doses of β-blockers and alcohol abstinence improve long-term rebleeding and mortality in cirrhotic patients after an acute variceal bleeding

Authors

  • Laura Muntaner,

    1. Liver Unit-Department of Internal Medicine, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
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  • José Trinidad Altamirano,

    1. Liver Unit-Department of Internal Medicine, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
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  • Salvador Augustin,

    1. Liver Unit-Department of Internal Medicine, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
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  • Antonio González,

    1. Liver Unit-Department of Internal Medicine, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
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  • Rafael Esteban,

    1. Liver Unit-Department of Internal Medicine, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
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  • Jaime Guardia,

    1. Liver Unit-Department of Internal Medicine, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
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  • Joan Genescà

    1. Liver Unit-Department of Internal Medicine, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
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Correspondence
Salvador Augustin, MD, Liver Unit-Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
Tel:+34 932 746 140
Fax:+34 932 746 068
e-mail: saugustin@vhebron.net

Abstract

Background & aim: We analysed prognostic indicators of long-term outcome in cirrhotic patients surviving the critical 6-week period after an episode of acute variceal bleeding.

Methods: All patients with oesophageal variceal bleeding from 2001–2007 were prospectively registered. Follow-up extended from day 42 after index bleeding to last visit, death or liver transplantation (LT). Multivariate Cox regression analysis was performed.

Results: Two hundred and fifty variceal bleeding episodes were registered. Fifty-four patients (26%) died before day 42, and 123 patients were finally included. Median follow-up was 23.5 months. Nadolol±nitrates alone or combined with variceal ligation were used as prophylaxis in 93% of patients. During follow-up, 43 patients (35%) experienced rebleeding, 34 (27.5%) died and 10 (8%) were transplanted. Follow-up β-blocker dose (HR 0.993, 95% CI 0.987–0.998, P=0.027) and alcohol abstinence (HR 0.324, 95% CI 0.152–0.691, P=0.004) were independent rebleeding predictors. The Cox analysis disclosed the Child–Pugh score (HR 1.24, 95% CI 1.08–1.43, P=0.002), creatinine (HR 1.82, 95% CI 1.17–2.82, P=0.008), β-blocker dose (HR 0.992, 95% CI 0.987–0.997, P=0.003), viral cirrhosis (HR 2.72, 95% CI 1.31–5.67, P=0.008), hepatocellular carcinoma (HR 9.44, 95% CI 3.54–25.20, P<0.001) and alcohol abstinence (HR 0.29, 95% CI 0.13–0.62, P=0.002) to be independent prognostic markers for mortality/LT.

Conclusion: High doses of β-blockers and alcohol abstinence decrease rebleeding and mortality in cirrhotic patients surviving the 6-week period after acute variceal bleeding.

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