Survival outcomes and predictors of mortality,re-bleeding and complications for acute severe variceal bleeding requiring balloon tamponade  

作　　者：Charlotte Y Keung Aparna Morgan Suong T Le Marcus Robertson Paul Urquhart Michael P Swan 

机构地区：[1]Department of Gastroenterology,Monash Health,Melbourne 3168,Victoria,Australia [2]Department of Gastroenterology,Eastern Health,Melbourne 3128,Victoria,Australia [3]Department of Medicine,Monash University,Melbourne 3168,Victoria,Australia [4]Monash Digital Therapeutics and Innovation Laboratory,Monash University,Melbourne 3168,Victoria,Australia

出　　处：《World Journal of Hepatology》2022年第8期1584-1597,共14页世界肝病学杂志（英文版）（电子版）

摘　　要：BACKGROUND Acute severe variceal bleeding(AVB)refractory to medical and endoscopic therapy is infrequent but associated with high mortality.Historical cohort studies from 1970-1980s no longer represent the current population as balloon tamponade is no longer first-line therapy for variceal bleeding;treatments including vasoactive therapies,intravenous antibiotics,endoscopic variceal band ligation are routinely used,and there is improved access to definitive treatments including transjugular intrahepatic portosystemic shunts.However,only a few studies from the current era exist to describe the practice of balloon tamponade,its outcomes,and predictors with a requirement for further updated information.AIM To describe current management of AVB requiring balloon tamponade and identify the outcomes and predictors of mortality,re-bleeding and complications.METHODS A retrospective multi-centre cohort study of 80 adult patients across two large tertiary health networks from 2008 to 2019 in Australia who underwent balloon tamponade using a Sengstaken-Blakemore tube(SBT)were included for analysis.Patients were identified using coding for balloon tamponade.The primary outcome of this study was all-cause mortality at 6 wk after the index AVB.Secondary outcomes included re-bleeding during hospitalisation and complications of balloon tamponade.Predictors of these outcomes were determined using univariate and multivariate binomial regression.RESULTS The all-cause mortality rates during admission and at 6-,26-and 52 wk were 48.8%,51.2%and 53.8%,respectively.Primary haemostasis was achieved in 91.3%and re-bleeding during hospitalisation occurred in 34.2%.Independent predictors of 6 wk mortality on multivariate analysis included the Model for Endstage Liver disease(MELD)score(OR 1.21,95%CI 1.06-1.41,P=0.006),advanced hepatocellular carcinoma(OR 11.51,95%CI 1.61-82.20,P=0.015)and re-bleeding(OR 13.06,95%CI 3.06-55.71,P<0.001).There were no relevant predictors of re-bleeding but a large proportion in which this occurred did not surv

关 键 词：Balloon tamponade Acute variceal bleeding Sengstaken-Blakemore tube MORTALITY COMPLICATIONS HAEMOSTASIS 

分 类 号：R543.6[医药卫生—心血管疾病]