Influence of Gastroesophageal Variceal Bleeding on One-year Mortality and Associated Factors in Patients with Liver Cirrhosis

Abstract

Background Esophageal and gastric varices bleeding (EGVB) is one of the most common and dangerous complications of liver cirrhosis. However, whether EGVB affects the one-year mortality of patients with liver cirrhosis remains unclear. Objective To explore the influence of EGVB on one-year mortality and influencing factors in patients with liver cirrhosis, providing guidance for follow-up for these patients. Methods This study selected liver cirrhosis patients who were admitted to the Affiliated Changsha Central Hospital, University of South China from January 2015 to May 2021. The patients were divided into EGVB group and non-bleeding (control group) by the prevalence of EGVB at the first consultation. One-year routine follow-up was conducted with them until the date of death from liver cirrhosis or the termination follow-up day. Logistic regression analysis was conducted for screening the factors affecting one-year mortality. Furthermore, the covariates between the two groups were matched in a 1∶2 ratio using propensity score matching (PSM) . Then, Logistic regression analyses were applied to identify and compare the influencing factors of one-year mortality in the groups. Results Among the 812 patients enrolled, 158 (19.5%) were diagnosed with EGVB, and the other 654 (80.5%) had no EGVB. The one-year mortality of the EGVB and control groups was 13.3% (21/158) and 13.9% (91/654) , respectively, showing no significant difference (P>0.05) . Before PSM, multivariate Logistic regression analysis showed that elevated serum sodium level〔OR=0.95, 95%CI (0.90, 0.99) 〕 and albumin level [OR=0.95, 95%CI (0.91, 0.99) 〕 were associated with a decreased risk of one-year mortality (P<0.05) , while older age〔OR=1.04, 95%CI (1.02, 1.06) 〕 and hepatic encephalopathy (grade Ⅲ or Ⅳ) 〔OR=3.72, 95%CI (1.21, 11.37) 〕were associated with an increased risk (P<0.05) . After PSM, the one-year mortality was the same in EGVB group (n=145) and control group (n=290) 〔12.4% (18/145) vs 12.4% (36/290) 〕, showing no significant difference (P>0.05) . Moreover, elevated blood urea nitrogen (BUN) 〔OR=1.15, 95%CI (1.02, 1.29) 〕 was an independent risk factor for one-year mortality in EGVB group (P<0.05) , while older age〔OR=1.09, 95%CI (1.04, 1.14) 〕 and elevated neutrophil-to-lymphocyte ratio (NLR) 〔OR=1.09, 95%CI (1.00, 1.18) 〕 acted as independent risk factors for one-year mortality in the control group (P<0.05) . Conclusion EGVB had no obvious association with one-year mortality in liver cirrhosis patients. But there were considerable discrepancies in the risk factors affecting one-year mortality between the two groups. Elevated BUN was the independent risk factor for one-year mortality in the EGVB group, while older age and elevated NLR were independent risk factors for one-year mortality in the control group. These results provide a new reference for clinical follow-up and treatment of patients with liver cirrhosis.

Keywords

• liver cirrhosis|esophageal and gastric varices|esophageal and gastric varices bleeding|prognosis|propensity score matching|root cause analysis