عوامل پیش‌بینی کننده خون‌ریزی مجدد در خون‌ریزی از واریس مری در بیماران بستری در بخش گوارش بیمارستان امام خمینی 87-86

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, 100 patients with variceal bleeding, whom were admitted to the Tabriz Imam Khomeini Hospital from June 2007 to May 2008, 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 68 patients with mean age of 49.88±16.42 were in non-bleeding and 32 patients with mean age of 54.2 ±19.8 were in rebleeding groups, respectively. The size of varices (P=0.046), encephalopathy (P<0.05), ascites (P<0.005), and CTP classification (P<0.0001) had predictive effects on rebleeding. Overall, 12 were CTP class A, 59 CTP class B, and 29 CTP class C. The level of sensitivity to CTP and bilirubin with the aid of ROC evaluation was found to be higher than 85% and 62%, 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.