[Prediction of bleeding risks and death in cirrhosis based on hemodynamic and metabolic variables. A study of patients with esophageal varices without previous bleeding].

As identification of patients with liver cirrhosis who are at risk of bleeding or death is essential in terms of prophylaxis, we have determined the prognostic influence of various patient characteristics on risk of bleeding and death. Fifty-five cirrhotic patients with oesophageal varices without previous bleeding were included in the study and followed up after a medium observation period of 446 days (range:5-1211 days). A total of 55 clinical, biochemical, haemodynamic, and endoscopic variables were classified as either systemic haemodynamic, portal haemodynamic, or metabolic. Using univariate analysis the following variables showed a significant relation to an increased risk of bleeding or death: high plasma volume (p < 0.02), high azygos blood flow (p < 0.004), high hepatic venous pressure gradient (p < 0.02), marked prominence of varices (p < 0.05), poor nutritional status (p < 0.0001), low clotting factor 2, 7, 10 (p < 0.002), low incapacitation index (p < 0.004), low serum albumin (p < 0.005), high bilirubin (p = 0.05), high alkaline phosphatases (p < 0.02), low arterial oxygen saturation (p = 0.02), and encephalopathy (p < 0.007). In a Cox regression model poor nutritional status (p < 0.00005), serum bilirubin (p < 0.001), short central circulation time (p < 0.03), low serum albumin (p < 0.02), and low index of clotting factor 2, 7, 10 (p < 0.05) were independently associated with higher risk. In conclusion, the results support the prognostic value of metabolic variables as earlier described. The prognostic significance of central circulation time stresses the importance of the hyperdynamic systemic circulation in the increased risk.(ABSTRACT TRUNCATED AT 250 WORDS)