Competing interests: The authors report no conflicts of interest.
Predictors of in-hospital mortality after acute variceal bleeding in patients with hepatocellular carcinoma and concurrent main portal vein thrombosis
Article first published online: 27 JAN 2014
© 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 29, Issue 2, pages 344–351, February 2014
How to Cite
Han, M.-L., Chen, C.-C., Kuo, S.-H., Hsu, W.-F., Liou, J.-M., Wu, M.-S. and Wang, H.-P. (2014), Predictors of in-hospital mortality after acute variceal bleeding in patients with hepatocellular carcinoma and concurrent main portal vein thrombosis. Journal of Gastroenterology and Hepatology, 29: 344–351. doi: 10.1111/jgh.12341
Specific author contributions: Ming-Lun Han, Chieh-Chang Chen, and Jyh-Ming Liou were responsible for statistical analysis and drafting of the manuscript. Ming-Lun Han, Shih-Hao Kuo, and Wen-Feng Hsu contributed to the collection of data. Ming-Shiang Wu contributed to the interpretation of results. Hsiu-Po Wang contributed to the concept formulation, study design, interpretation of results, and preparation of the manuscript. All authors have read the manuscript and approve its submission.
- Issue published online: 27 JAN 2014
- Article first published online: 27 JAN 2014
- Accepted manuscript online: 22 JUL 2013 05:12AM EST
- Manuscript Accepted: 27 JUN 2013
- acute variceal bleeding;
- endoscopic injection of tissue adhesives;
- endoscopic variceal ligation;
- hepatocellular carcinoma;
- portal vein thrombosis
Background and Aim
Risk factors for acute variceal bleeding in patients with hepatocellular carcinoma (HCC) and concurrent main portal vein thrombosis (PVT) remain unclear. We aimed to determine risk factors of in-hospital mortality after acute variceal bleeding for HCC patients with concurrent main PVT.
We conducted a retrospective analysis of 102 HCC patients (83% men and 17% women) with concurrent main PVT and acute variceal bleeding. All patients received emergent endoscopy to define the bleeding source. Multivariable Cox proportional hazard regression analysis consisting of clinical, laboratory, and endoscopic parameters was performed to identify predictive factors for intrahospital mortality.
Twenty-eight (27.5%) patients died within admission. The median survival of all patients was 56 days. Multivariable Cox proportional hazard regression analyses revealed Child-Pugh score (adjusted hazard ratio [aHR]: 1.29 for each point; 95% confidence interval [CI]: 1.11–1.50), active bleeding on index endoscopy (aHR: 7.50; 95% CI: 3.05–18.4), esophageal varices as the bleeder (compared with gastric varices, aHR: 14.3; 95% CI: 3.12–66.1), failure to control bleeding (aHR: 38.0; 95% CI: 7.44–194), and serum creatinine (aHR: 1.28 for each increase of 1 mg/dL; 95% CI: 1.09–1.50) independently predicted in-hospital mortality.
Hepatic reserve, active bleeding on index endoscopy, failure to control bleeding, esophageal varices as the bleeder when compared with gastric varices, and renal function were independent predictive factors for in-hospital mortality in HCC patients with acute variceal bleeding and concurrent main PVT.