Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study

E. Brocchi, G. Caletti, G. Brambilla, L. La Mantia, G. Lupinacci, G. Pisano, G. Puerari, A. Zambelli, S. Barbagli, P. Ciani, L. Manneschi, S. Brunati, R. Curioni, D. Agape, F. Antoniozzi, P. Arcidiacono, E. Ballarin, M. Basilico, P. Bocchia

Research output: Contribution to journalArticle

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Abstract

We conducted a prospective study of 321 patients with cirrhosis of the liver and esophageal varices with no history of bleeding to see whether a comprehensive analysis of their clinical features and of the endoscopic appearances of their varices could help to identify those at highest risk for bleeding. Varices were classified endoscopically as suggested by the Japanese Research Society for Portal Hypertension. Patients were followed for 1 to 38 months (median, 23), during which 85 patients (26.5 percent) bled. Multiple regression analaysis (Cox's model) revealed that the risk of bleeding was significantly related to the patient's modified Child class (an index of liver dysfunction based on serum albumin concentration, bilirubin level, prothrombin time, and the presence of ascites and encephalopathy), the size of the varices, and the presence of red wale markings (longitudinal dilated venules resembling whip marks) on the varices. A prognostic index based on these variables was devised that enabled us to identify a subset of patients with a one-year incidence of bleeding exceeding 65 percent, The index was prospectively validated on a independent sample of 75 patients with varices and no history of bleeding. We conclude that our prognostic index, which identifies groups of patients with one-year probabilities of bleeding ranging from 6 to 76 percent, can be used to identify candidates for prophylactic treatment.

Original languageEnglish
Pages (from-to)983-989
Number of pages7
JournalNew England Journal of Medicine
Volume319
Issue number15
Publication statusPublished - 1988

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Esophageal and Gastric Varices
Liver Cirrhosis
Multicenter Studies
Varicose Veins
Prospective Studies
Hemorrhage
Venules
Prothrombin Time
Wales
Brain Diseases
Portal Hypertension
Bilirubin
Proportional Hazards Models
Ascites
Serum Albumin
Liver Diseases
Incidence
Research

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Brocchi, E., Caletti, G., Brambilla, G., La Mantia, L., Lupinacci, G., Pisano, G., ... Bocchia, P. (1988). Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. New England Journal of Medicine, 319(15), 983-989.

Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. / Brocchi, E.; Caletti, G.; Brambilla, G.; La Mantia, L.; Lupinacci, G.; Pisano, G.; Puerari, G.; Zambelli, A.; Barbagli, S.; Ciani, P.; Manneschi, L.; Brunati, S.; Curioni, R.; Agape, D.; Antoniozzi, F.; Arcidiacono, P.; Ballarin, E.; Basilico, M.; Bocchia, P.

In: New England Journal of Medicine, Vol. 319, No. 15, 1988, p. 983-989.

Research output: Contribution to journalArticle

Brocchi, E, Caletti, G, Brambilla, G, La Mantia, L, Lupinacci, G, Pisano, G, Puerari, G, Zambelli, A, Barbagli, S, Ciani, P, Manneschi, L, Brunati, S, Curioni, R, Agape, D, Antoniozzi, F, Arcidiacono, P, Ballarin, E, Basilico, M & Bocchia, P 1988, 'Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study', New England Journal of Medicine, vol. 319, no. 15, pp. 983-989.
Brocchi, E. ; Caletti, G. ; Brambilla, G. ; La Mantia, L. ; Lupinacci, G. ; Pisano, G. ; Puerari, G. ; Zambelli, A. ; Barbagli, S. ; Ciani, P. ; Manneschi, L. ; Brunati, S. ; Curioni, R. ; Agape, D. ; Antoniozzi, F. ; Arcidiacono, P. ; Ballarin, E. ; Basilico, M. ; Bocchia, P. / Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. In: New England Journal of Medicine. 1988 ; Vol. 319, No. 15. pp. 983-989.
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AU - Brocchi, E.

AU - Caletti, G.

AU - Brambilla, G.

AU - La Mantia, L.

AU - Lupinacci, G.

AU - Pisano, G.

AU - Puerari, G.

AU - Zambelli, A.

AU - Barbagli, S.

AU - Ciani, P.

AU - Manneschi, L.

AU - Brunati, S.

AU - Curioni, R.

AU - Agape, D.

AU - Antoniozzi, F.

AU - Arcidiacono, P.

AU - Ballarin, E.

AU - Basilico, M.

AU - Bocchia, P.

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