Prognosis of hepatic cirrhosis patients with esophageal or gastric variceal hemorrhage: multivariate analysis

<正> Objective: To study the effect of bacterial infection,use of antibiotics, active bleeding at endoscopy, andthe severity of liver disease as prognostic factors inhepatic cirrhotic patients during the first 5 days afterthe episode of esophageal or gastric variceal hemor-rhage.Methods: Seventy-six hepatic cirrhosis patients withesophageal or gastric variceal bleeding were enrolled.Bleeding was managed in a standardized protocol u-sing octreotide and vasopressin in sclerotherapy orband ligation for active bleeding at endoscopy. Thescreening protocol for bacterial infection consisted ofchest radiograph; blood, urine and ascitic fluid cul-tures; the severity of liver disease shown by Child-Pugh score.Results: Active bleeding was observed at endoscopyin 40 patients (53%). Failure to control bleedingWithin 5 days occurred in 36 patients (45%). Empir-ical antibiotic treatment was used in 53 patients(67%), whereas bacterial infections were documen-ted in 43 patients (57%). Multivariate analysisshowed that proven bacterial infection (P<0.01) orantibiotic use (P<0.05) as well as active bleeding atendoscopy (P<0.01) and Child-Pugh score (P<0.01) were independent prognostic factors of failureto control bleeding.Conclusion: Bacterial infection is associated with fai-lure to control esophageal or gastric variceal bleedingin hepatic cirrhotic patients.