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Abstract：
Despite secondary-prophylaxis with β-blockers and endoscopic-variceal-ligation rebleeding is frequent, particularly within the first-6-weeks. Early-rebleeding may have greater impact on death-risk than late rebleeding, which may affect therapy. We assessed whether the influence of rebleeding on long-term survival of patients on secondary-prophylaxis is greater in patients with early-rebleeding.
369 patients with cirrhosis were consecutively included once recovered from first variceal-bleeding. The impact of rebleeding on survival was investigated according to whether it occurred within 6-weeks (early-rebleeding) or later (late-rebleeding).
During 46-months of follow-up (IQR: 14-61), 45 patients (12%) had early-rebleeding, 74(20%) had late-rebleeding and 250(68%) had not rebleeding. Mortality risk was higher in early-rebleeding group vs. late-rebleeding (HR = 0.476, 95%CI = 0.318-0.712, p < 0.001) and was similar in late-rebleeding group vs. no-rebleeding (HR = 0.902, 95%CI = 0.749-1.086, p = 0.271). Adjusting for baseline risk-factors, early-rebleeding was independently associated with mortality-risk (HR = 1.58, 95%CI = 1.02-2.45; p = 0.04). Child-Pugh&MELD scores improved at 3rd-4th-week only in patients without early-rebleeding (p < 0.05). Presence of ascites or encephalopathy, MELD-score>12 and HVPG>20 mmHg identified patients at risk of early-rebleeding.
Patients with early-rebleeding have higher risk of death than patients without rebleeding and even than those rebleeding later. Our results suggest that patients at risk of early rebleeding might benefit from preemptive therapies such as early-TIPS.
369 patients with cirrhosis were consecutively included once recovered from first variceal-bleeding. The impact of rebleeding on survival was investigated according to whether it occurred within 6-weeks (early-rebleeding) or later (late-rebleeding).
During 46-months of follow-up (IQR: 14-61), 45 patients (12%) had early-rebleeding, 74(20%) had late-rebleeding and 250(68%) had not rebleeding. Mortality risk was higher in early-rebleeding group vs. late-rebleeding (HR = 0.476, 95%CI = 0.318-0.712, p < 0.001) and was similar in late-rebleeding group vs. no-rebleeding (HR = 0.902, 95%CI = 0.749-1.086, p = 0.271). Adjusting for baseline risk-factors, early-rebleeding was independently associated with mortality-risk (HR = 1.58, 95%CI = 1.02-2.45; p = 0.04). Child-Pugh&MELD scores improved at 3rd-4th-week only in patients without early-rebleeding (p < 0.05). Presence of ascites or encephalopathy, MELD-score>12 and HVPG>20 mmHg identified patients at risk of early-rebleeding.
Patients with early-rebleeding have higher risk of death than patients without rebleeding and even than those rebleeding later. Our results suggest that patients at risk of early rebleeding might benefit from preemptive therapies such as early-TIPS.
摘要：
尽管使用β受体阻滞剂和内镜静脉曲张结扎术进行二级预防，但仍经常发生再出血，特别是在前6周内。与晚期再出血相比，早期再出血对死亡风险的影响更大。这可能会影响治疗。我们评估了在早期再出血患者中，再出血对二级预防患者长期生存的影响是否更大。
369例肝硬化患者一旦从首次静脉曲张破裂出血中恢复，就被连续纳入。根据再出血是否发生在6周内（早期再出血）或更晚（晚期再出血）来研究再出血对生存率的影响。
在46个月的随访期间（IQR：14-61），45例患者（12%）有早期再出血，74（20％）有晚期再出血，250（68％）没有再出血。早期再出血组的死亡率风险较高。晚期再出血组（HR=0.476，95CI=0.318-0.712，p<0.001），与晚期再出血组相似。无再出血(HR=0.902,95CI=0.749-1.086,p=0.271)。调整基线风险因素，早期再出血与死亡风险独立相关(HR=1.58,95CI=1.02~2.45;p=0.04).Child-Pugh&MELD评分仅在无早期再出血的患者中在第3-4周时改善(p<0.05)。存在腹水或脑病，MELD评分>12和HVPG>20mmHg确定患者有早期再出血的风险。
早期再出血患者的死亡风险高于未再出血患者，甚至高于晚期再出血患者。我们的结果表明，有早期再出血风险的患者可能会从早期TIPS等抢先治疗中受益。
369例肝硬化患者一旦从首次静脉曲张破裂出血中恢复，就被连续纳入。根据再出血是否发生在6周内（早期再出血）或更晚（晚期再出血）来研究再出血对生存率的影响。
在46个月的随访期间（IQR：14-61），45例患者（12%）有早期再出血，74（20％）有晚期再出血，250（68％）没有再出血。早期再出血组的死亡率风险较高。晚期再出血组（HR=0.476，95CI=0.318-0.712，p<0.001），与晚期再出血组相似。无再出血(HR=0.902,95CI=0.749-1.086,p=0.271)。调整基线风险因素，早期再出血与死亡风险独立相关(HR=1.58,95CI=1.02~2.45;p=0.04).Child-Pugh&MELD评分仅在无早期再出血的患者中在第3-4周时改善(p<0.05)。存在腹水或脑病，MELD评分>12和HVPG>20mmHg确定患者有早期再出血的风险。
早期再出血患者的死亡风险高于未再出血患者，甚至高于晚期再出血患者。我们的结果表明，有早期再出血风险的患者可能会从早期TIPS等抢先治疗中受益。
