Predicting Factors of Rebleeding in Variceal Hemorrhage in Patients Hospitalized in Tabriz Imam Khomeini Hospital during ۲۰۰۷-۲۰۰۸

Background and Objective: Esophageal variceal bleeding is associated with a high mortality rate and expensive hospitalization costs. By diagnosing predicting factors of rebleeding at admission, and proper course of action, we can minimize the rates of mortality rebleeding. The aim of this study was to determine the predicting factors of rebleeding in patients hospitalized because of variceal hemorrhage by Child Turcotte Pugh Classification. Materials and Methods: In this case-control study, ۱۰۰ patients with variceal bleeding, whom were admitted to the Tabriz Imam Khomeini Hospital from June ۲۰۰۷ to May ۲۰۰۸, were recruited. The demographic characteristics including age, gender, etiology, CTP classification, and also various clinical, laboratory, and endoscopic data were recorded for each patient. Patients were divided into case and control groups (with or without variceal bleeding) and predictive factors of rebleeding were determined. Results: A total of ۶۸ patients with mean age of ۴۹.۸۸±۱۶.۴۲ were in non-bleeding and ۳۲ patients with mean age of ۵۴.۲ ±۱۹.۸ were in rebleeding groups, respectively. The size of varices (P=۰.۰۴۶), encephalopathy (P<۰.۰۵), ascites (P<۰.۰۰۵), and CTP classification (P<۰.۰۰۰۱) had predictive effects on rebleeding. Overall, ۱۲ were CTP class A, ۵۹ CTP class B, and ۲۹ CTP class C. The level of sensitivity to CTP and bilirubin with the aid of ROC evaluation was found to be higher than ۸۵% and ۶۲%, respectively. Conclusion: Determination of the CTP class and grade at admission, in patients with variceal bleeding can provide useful prognostic information. In this study, patients with CTP class B were strongly susceptible to rebleeding. The risk of rebleeding increases significantly in patients with higher levels of bilirubin, or severe ascites or encephalopathy, and they require prophylactic measures.

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Keywords: Esophageal varices , Variceal bleeding , Rebleeding , CTP classification