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Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study.
N Engl J Med. 1988 Oct 13; 319(15):983-9.NEJM

Abstract

We conducted a prospective study of 321 patients with cirrhosis of the liver and esophageal varices with no history of bleeding to see whether a comprehensive analysis of their clinical features and of the endoscopic appearances of their varices could help to identify those at highest risk for bleeding. Varices were classified endoscopically as suggested by the Japanese Research Society for Portal Hypertension. Patients were followed for 1 to 38 months (median, 23), during which 85 patients (26.5 percent) bled. Multiple regression analysis (Cox's model) revealed that the risk of bleeding was significantly related to the patient's modified Child class (an index of liver dysfunction based on serum albumin concentration, bilirubin level, prothrombin time, and the presence of ascites and encephalopathy), the size of the varices, and the presence of red wale markings (longitudinal dilated venules resembling whip marks) on the varices. A prognostic index based on these variables was devised that enabled us to identify a subset of patients with a one-year incidence of bleeding exceeding 65 percent. The index was prospectively validated on an independent sample of 75 patients with varices and no history of bleeding. We conclude that our prognostic index, which identifies groups of patients with one-year probabilities of bleeding ranging from 6 to 76 percent, can be used to identify candidates for prophylactic treatment.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

3262200

Citation

North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. "Prediction of the First Variceal Hemorrhage in Patients With Cirrhosis of the Liver and Esophageal Varices. a Prospective Multicenter Study." The New England Journal of Medicine, vol. 319, no. 15, 1988, pp. 983-9.
North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med. 1988;319(15):983-9.
North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. (1988). Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. The New England Journal of Medicine, 319(15), 983-9.
North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the First Variceal Hemorrhage in Patients With Cirrhosis of the Liver and Esophageal Varices. a Prospective Multicenter Study. N Engl J Med. 1988 Oct 13;319(15):983-9. PubMed PMID: 3262200.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. A1 - ,, PY - 1988/10/13/pubmed PY - 1988/10/13/medline PY - 1988/10/13/entrez SP - 983 EP - 9 JF - The New England journal of medicine JO - N Engl J Med VL - 319 IS - 15 N2 - We conducted a prospective study of 321 patients with cirrhosis of the liver and esophageal varices with no history of bleeding to see whether a comprehensive analysis of their clinical features and of the endoscopic appearances of their varices could help to identify those at highest risk for bleeding. Varices were classified endoscopically as suggested by the Japanese Research Society for Portal Hypertension. Patients were followed for 1 to 38 months (median, 23), during which 85 patients (26.5 percent) bled. Multiple regression analysis (Cox's model) revealed that the risk of bleeding was significantly related to the patient's modified Child class (an index of liver dysfunction based on serum albumin concentration, bilirubin level, prothrombin time, and the presence of ascites and encephalopathy), the size of the varices, and the presence of red wale markings (longitudinal dilated venules resembling whip marks) on the varices. A prognostic index based on these variables was devised that enabled us to identify a subset of patients with a one-year incidence of bleeding exceeding 65 percent. The index was prospectively validated on an independent sample of 75 patients with varices and no history of bleeding. We conclude that our prognostic index, which identifies groups of patients with one-year probabilities of bleeding ranging from 6 to 76 percent, can be used to identify candidates for prophylactic treatment. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/3262200/Prediction_of_the_first_variceal_hemorrhage_in_patients_with_cirrhosis_of_the_liver_and_esophageal_varices__A_prospective_multicenter_study_ L2 - https://www.nejm.org/doi/10.1056/NEJM198810133191505?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -