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Valoración del pronóstico a corto y largo plazo de pacientes con cirrosis y hemorragia digestiva por hipertensión portal

DOI: 10.4321/S1130-01082009000400002

Keywords: prognosis, variceal bleeding, portal hypertension, child-turcotte-pugh score, meld score.

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objective: to evaluate the efficacy of various indicators in predicting short- and long-term survival in patients with cirrhosis and acute variceal bleeding. material and methods: prognostic indicators were calculated for a cohort of 201 cirrhotic patients with acute variceal bleeding hospitalized in our center, a third-level teaching hospital. the studied variables were: age, sex, etiology of cirrhosis, endoscopic findings, previous variceal bleeding episodes, human immunodeficiency virus (hiv) infection, hepatocellular carcinoma (hcc), infection during episode, and child-turcotte-pugh (ctp) and model for end-stage liver disease (meld) scores within 24 hours of bleeding onset. patients were followed up for at least 6 months until death, liver transplantation, or end of observation. results: median follow-up was 66.85 weeks (range 0-432.4). the 6-week, 3-month, 12-month and 36-month mortality rates were 22.9, 24.9, 34.3, and 39.8%, respectively. age ≥ 65 years, presence of hcc, ctp score ≥ 10, and meld score ≥ 18 were the variables associated with mortality in the multivariate analysis. the accuracy of meld scores as predictors of 6-week, 3-month, 12-month, and 36-month mortality was better than that of ctp scores (c-statistics: 6 week meld 0.804, ctp 0.762; 3-month meld 0.794, ctp 0.760; 12-month meld 0.766, ctp 0.741; 36 month meld 0.737, ctp 0.717). conclusion: meld and ctp scores together with age and a diagnosis of hepatocellular carcinoma are useful indicators to assess the short- and long-term prognosis of patients with acute variceal bleeding.


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