Predictive Factors of Bleeding from Esophageal Varices in Patients with Liver Cirrhosis and Portal Hypertension

Variceal bleeding is the most life-threating complication in liver cirrhosis. The aim of this study was to ascertain the risk factors of bleeding from esophageal varices.52 patients with liver cirrhosis and portal hypertension were included in prospective study. We analyzed the severity of liver dysfunction according to Child's classification, coagulation parameters, and endoscopic parameters: size, color, location of varices, and the presence of "red signs". Varices were classified as small, medium and large.Esophageal varices were found in 76.9% of the patients with liver cirrhosis and portal hypertension. Small varices were present in 10%, medium in 25% and large in 65% patients. 55% of them had variceal bleeding. Variceal bleeding was present in 50% patients with medium and in 65.38% patients with large varices. There was no bleeding in patients with small varices.Endoscopy revealed "red signs" before bleeding in 85% patients with large varices. There was a higher incidence of variceal bleeding in Child's group B. There were no significant differences (p>0.05) of the coagulation parameters in patients with and without variceal bleeding. Rebleeding was present in 86.36% patients. Most of them (52.63%) rebled between 7 weeks and 12 months after the first episode of variceal bleeding. In the patients with the most severe hepatocellular dysfunction (Child's group C) period between the first bleeding and rebleeding was the shortest (mean 20.8 days). Our study revealed association between the first bleeding and large varices and the "red signs". Coagulation disorders and hepatic dysfunction were not related to the initial episode of variceal bleeding. The risk of early rebleeding was higher in patients with severe hepatic dysfunction (Child's class C).