Risk factors for early rebleeding and mortality in acute variceal hemorrhage

AIM:To investigate the risk factors for 6-wk rebleeding and mortality in acute variceal hemorrhage(AVH)patients treated by percutaneous transhepatic variceal embolization(PTVE).METHODS:A retrospective cohort study of AVH patients who had undergone PTVE treatment was conducted between January 2010 and December 2012.Demographic information,medical histories,physical examination findings,and laboratory test results were collected.The PTVE procedure was performed as a rescue therapy for patients who failed endoscopic and pharmacologic treatment.Survival analysis was estimated using the Kaplan-Meier method and compared using the log-rank test.The multivariate analysis was performed using the Cox regression test to identify independent risk factors for rebleeding and mortality.RESULTS:One hundred and one patients were included;71 were males and the average age was 51 years.Twenty-one patients rebled within 6 wk.Patients with high-risk stigmata,PTVE with trunk obliteration,and a hepatic vein pressure gradient(HVPG)≥20 mm Hg were at increased risk for rebleeding(OR=5.279,95%CI:2.782-38.454,P=0.003;OR=4.309,95%CI:=2.144-11.793,P<0.001;and OR=1.534,95%CI:1.062-2.216,P=0.022,respectively).Thirteen patients died within 6 wk.A model for end-stage liver disease(MELD)score≥18 and an HVPG≥20 mm Hg were associated with 6-wk mortality(OR=2.162,95%CI:1.145-4.084,P=0.017 and OR=1.423,95%CI:1.222-1.657,P<0.001,respectively).CONCLUSION:MELD score and HVPG in combination allow for early identification of patients with AVH who are at substantially increased risk of death over the short term.

Increased expression of matrix metalloproteinase-9 associated with gastric ulcer recurrence

AIM: To compare matrix metalloproteinase (MMP)-9 and tissue inhibitor of metalloproteinase (TIMP)-1 in gastric ulcer (GU) and chronic superficial gastritis (CSG). METHODS: This study enrolled 63 patients with GU and 25 patients with CSG. During upper gastroduodenal endoscopy, we took samples of gastric mucosa from the antrum and ulcer site from patients with GU, and samples of antral mucosa from patients with CSG. Mucosal biopsy tissues were cultured for 24 h, and the culture supernatant was measured for levels of MMP-9 and TIMP-1. After receiving eradication therapy for Helicobacter pylori (H. pylori ) and 8 wk proton-pump inhibitor therapy for GU, follow-up endoscopy examination was performed after 6 mo and whenever severe symptoms occurred. RESULTS: Levels of MMP-9 and TIMP-1 at the ulcer site or in the antrum were significantly higher in GU than CSG patients. MMP-9 levels at the ulcer site were significantly higher than in the antrum in GU patients, and had a significantly positive correlation with TIMP-1. MMP-9 levels were significantly higher in H. pylori -positive than H. pylori -negative GU and CSG patients. Levels of MMP-9 or TIMP-1 at the ulcer site were associated with the histological severity of activity and inflammation. About 57 GU patients were followed up, and seven had GU recurrence. H. pyloriinfection and MMP-9 levels were risk factors for the recurrence of GU adjusted for age and sex by multiple logistic regression analysis. CONCLUSION: MMP-9 may perform an important function in gastric ulcer formation and recurrence.