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 language | English |
|---|---|
| Pages (from-to) | 983-989 |
| Number of pages | 7 |
| Journal | New England Journal of Medicine |
| Volume | 319 |
| Issue number | 15 |
| Publication status | Published - 1988 |
Fingerprint
ASJC Scopus subject areas
- Medicine(all)
Cite this
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 journal › Article
}
TY - JOUR
T1 - Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study
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.
PY - 1988
Y1 - 1988
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=0023681215&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0023681215&partnerID=8YFLogxK
M3 - Article
C2 - 3262200
AN - SCOPUS:0023681215
VL - 319
SP - 983
EP - 989
JO - New England Journal of Medicine
JF - New England Journal of Medicine
SN - 0028-4793
IS - 15
ER -