AIM:To investigate the outcomes,as well as risk factors for 6-wk mortality,in patients with early rebleeding after endoscopic variceal band ligation (EVL) for esophageal variceal hemorrhage (EVH).METHODS:Among 817 EVL...AIM:To investigate the outcomes,as well as risk factors for 6-wk mortality,in patients with early rebleeding after endoscopic variceal band ligation (EVL) for esophageal variceal hemorrhage (EVH).METHODS:Among 817 EVL procedures performed for EVH between January 2007 and December 2008,128 patients with early rebleeding,defined as rebleeding within 6 wk after EVL,were enrolled for analysis.RESULT:The rate of early rebleeding after EVL for acute EVH was 15.6% (128/817).The 5-d,6-wk,3-mo,and 6-mo mortality rates were 7.8%,38.3%,55.5%,and 58.6%,respectively,in these early rebleeding patients.The use of beta-blockers,occurrence of hypovolemic shock,and higher model for end-stage liver disease (MELD) score at the time of rebleeding were independent predictors for 6-wk mortality.A cut-off value of 21.5 for the MELD score was found with an area under ROC curve of 0.862 (P < 0.001).The sensitivity,specificity,positive predictive value,and negative predictive value were 77.6%,81%,71.7%,and 85.3%,respectively.As for the 6-mo survival rate,patients with a MELD score ≥ 21.5 had a significantly lower survival rate than patients with a MELD score < 21.5 (P < 0.001).CONCLUSION:This study demonstrated that the MELD score is an easy and powerful predictor for 6-wk mortality and outcomes of patients with early rebleeding after EVL for EVH.展开更多
Objective: The aim of the study was to review the management of ruptured hepatocellular carcinoma (HCC) in a single teaching hospital over 13-year period; to determine the prognostic factor of in-hospital mortality an...Objective: The aim of the study was to review the management of ruptured hepatocellular carcinoma (HCC) in a single teaching hospital over 13-year period; to determine the prognostic factor of in-hospital mortality and evaluate the safety and efficacy of liver resection. Methods: A retrospective collection of medical records of 87 patients with spontaneous ruptured HCC was carried out. The 28 patients underwent emergency intervention including transarterial chemoembolization (TACE) and laparotomy with/without liver resection. Conservative treatment was performed in 59 patients and 16 of which underwent delayed hepatectomy or TACE. Results: The overall in-hospital mortality and median survival time was 54% and 22 days respectively. Albumin level (OR = 0.874, 95% CI: 0.778-0.973, P = 0.024), number of tumors (OR = 5.011, 95% CI: 1.015-24.750, P = 0.048) and laparotomy (OR = 0.069, 95% CI: 0.012-0.406, P = 0.003) were all independent factors affecting overall in-hospital mortality, but for patients undergone laparotomy, only total bilirubin level (OR = 1.138, 95% CI: 1.024-1.264, P = 0.016) was independent factor affecting overall in-hospital mortality. Age, total bilirubin level, maximum tumor size, number of tumors, portal vein tumor thrombosis and extra-hepatic metastasis were all significantly different between groups with laparotomy and without. There were no significant differences between emergency and delayed liver resection groups in in-hospital mortality (0 vs. 0), median survival time (788 vs. 750 days respectively) as well as 1-year and 3-year survival rates (66.7%, 44.4% vs. 70%, 30%, respectively) (P = 0.763, log-rank test). Conclusion: Both underlying chronic liver disease and tumor stage can affect the in-hospital mortality, but for patients undergone laparotomy, only total bilirubin level is independent factor. Surgeons are more prone to choose patients with younger age, better liver function and earlier tumor stage to do surgery. In well selected patients, both emergency and delayed liver resections are safe and could achieve prolonged survival.展开更多
文摘AIM:To investigate the outcomes,as well as risk factors for 6-wk mortality,in patients with early rebleeding after endoscopic variceal band ligation (EVL) for esophageal variceal hemorrhage (EVH).METHODS:Among 817 EVL procedures performed for EVH between January 2007 and December 2008,128 patients with early rebleeding,defined as rebleeding within 6 wk after EVL,were enrolled for analysis.RESULT:The rate of early rebleeding after EVL for acute EVH was 15.6% (128/817).The 5-d,6-wk,3-mo,and 6-mo mortality rates were 7.8%,38.3%,55.5%,and 58.6%,respectively,in these early rebleeding patients.The use of beta-blockers,occurrence of hypovolemic shock,and higher model for end-stage liver disease (MELD) score at the time of rebleeding were independent predictors for 6-wk mortality.A cut-off value of 21.5 for the MELD score was found with an area under ROC curve of 0.862 (P < 0.001).The sensitivity,specificity,positive predictive value,and negative predictive value were 77.6%,81%,71.7%,and 85.3%,respectively.As for the 6-mo survival rate,patients with a MELD score ≥ 21.5 had a significantly lower survival rate than patients with a MELD score < 21.5 (P < 0.001).CONCLUSION:This study demonstrated that the MELD score is an easy and powerful predictor for 6-wk mortality and outcomes of patients with early rebleeding after EVL for EVH.
文摘Objective: The aim of the study was to review the management of ruptured hepatocellular carcinoma (HCC) in a single teaching hospital over 13-year period; to determine the prognostic factor of in-hospital mortality and evaluate the safety and efficacy of liver resection. Methods: A retrospective collection of medical records of 87 patients with spontaneous ruptured HCC was carried out. The 28 patients underwent emergency intervention including transarterial chemoembolization (TACE) and laparotomy with/without liver resection. Conservative treatment was performed in 59 patients and 16 of which underwent delayed hepatectomy or TACE. Results: The overall in-hospital mortality and median survival time was 54% and 22 days respectively. Albumin level (OR = 0.874, 95% CI: 0.778-0.973, P = 0.024), number of tumors (OR = 5.011, 95% CI: 1.015-24.750, P = 0.048) and laparotomy (OR = 0.069, 95% CI: 0.012-0.406, P = 0.003) were all independent factors affecting overall in-hospital mortality, but for patients undergone laparotomy, only total bilirubin level (OR = 1.138, 95% CI: 1.024-1.264, P = 0.016) was independent factor affecting overall in-hospital mortality. Age, total bilirubin level, maximum tumor size, number of tumors, portal vein tumor thrombosis and extra-hepatic metastasis were all significantly different between groups with laparotomy and without. There were no significant differences between emergency and delayed liver resection groups in in-hospital mortality (0 vs. 0), median survival time (788 vs. 750 days respectively) as well as 1-year and 3-year survival rates (66.7%, 44.4% vs. 70%, 30%, respectively) (P = 0.763, log-rank test). Conclusion: Both underlying chronic liver disease and tumor stage can affect the in-hospital mortality, but for patients undergone laparotomy, only total bilirubin level is independent factor. Surgeons are more prone to choose patients with younger age, better liver function and earlier tumor stage to do surgery. In well selected patients, both emergency and delayed liver resections are safe and could achieve prolonged survival.
