medigraphic.com
ISSN 1729-519X (Print)

2018, Number 6

<< Back Next >>

Revista Habanera de Ciencias Médicas 2018; 17 (6)

Factors associated with mortality from variceal upper gastrointestinal bleeding

Moreira BOM, Rodríguez FZ, Manzano HE, Rodríguez HS, Romero GLI, Martínez PIM

Language: Spanish
References: 25
Page: 917-930
PDF size: 649.59 Kb.


ABSTRACT

Introduction: Variceal upper gastrointestinal bleeding constitutes a clinical surgical problem that still has an excessively high mortality.
Objective: To estimate the burden of mortality and its causes related to the disease, as well as the associated factors according to selected variables.
Material and Methods: An observational, descriptive, and cross-sectional study was conducted in 39 patients who were admitted with this diagnosis to the General Surgery Service of the "Saturnino Lora” Teaching Provincial Hospital of Santiago de Cuba during 2013-2016.
Results: Middle-aged male patients with several associated risk factors predominated in the study. Child-Pugh Class B and Classes II and III bleedings were the most frequent ones. The diagnosis was eminently clinical. Endoscopic treatment was carried out in three patients and the application of the Sengstaken-Blakemore tube was infrequent. 7 patients received surgical treatment, who account for the 43,8% of those who died. Mortality rate ranged from 22,2% in 2013 to 41,0% in 2016.
Conclusions: The persistence of variceal upper gastrointestinal bleeding responds to the poor use of endoscopic treatment and the non-use of somatostatin derivates. It is also associated with high levels of mortality, and in close relationship with a grade of advanced hepatic failure and urgent interventions. There was a correspondence between the direct causes of death and the disease under analysis.


REFERENCES

  1. Parra Pérez VF, Raymundo Cajo RM, Gutiérrez de Aranguren CF. Factores relacionados a resangrado y mortalidad en pacientes cirróticos con hemorragia variceal aguda en el Hospital Hipólito Unanue, Lima, Perú. Rev gastroenterol Perú [Internet]. 2013 [citado 28/10/2017]; 33(4): 314-320. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_ arttext&pid=S1022-51292013000400005

  2. Cruz Alonso JR, Anaya González JL, Pampín Camejo LE, Pérez Blanco D, Lopategui Cabezas I. Mortalidad por sangrado digestivo alto en el Hospital “Enrique Cabrera”. Rev Cubana Cir [Internet]. 2008 [citado 27/08/2017]; 47(4): [aprox.10 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext &pid=S0034-74932008000400006&lng=es

  3. Ríos E, Sierralta A, Abarzúa M, Bastías J, Barra MI. Comparación de la efectividad de la ligadura vs esclerosis endoscópica en pacientes con sangrado de várices esofágicas en el Hospital Hernán Henríquez de Temuco: estudio de cohortes comparativas. Rev. méd. Chile [Internet]. 2012 Jun [citado 16/05/2018]; 140 (6):713-718. Disponible en: https://scielo.conicyt.cl/scielo.php?script=sci_ar ttext&pid=S0034-98872012000600003&lng=es

  4. Motola-Kuba M, Escobedo-Arzate A, Tellez-Ávila F, Altamirano J, Aguilar Olivo N, González-Angulo A, et al. Validación de escalas pronósticas para la evolución clínica en pacientes cirróticos con hemorragia digestiva variceal aguda. Annals of Hepatology [Internet]. 2016 [citado 16/05/2018]; 15(6):895-901. Disponible en: http://www.medigraphic.com/cgibin/ new/resumen.cgi?IDARTICULO=69799

  5. Triantos C, Kalafateli M. Endoscopic treatment of esophageal varices in patients with liver cirrhosis. World J Gastroenterol. 2014; 20:13015-13026.

  6. Hwang JH, Shergill AK, Acosta RD, Chandrasekhara V, Chathadi KV, Decker GA, et al. The role of endoscopy in the management of variceal hemorrhage. Gastrointest Endosc [Internet]. 2014 [cited 28/11/2017]; 80(2):221– 227. Available from: https://www.asge.org/docs/defaultsource/ education/practice_guidelines/doc- 2014_the-role-of-endoscopy-in-themanagement- of-variceal-hemorrhage.pdf

  7. Waghray A, Waghray N, Kyprianou A, Menon KVN. Variceal screening in cirrhotic patients. J Hepatology. 2014; 60(S1):1594-9.

  8. Sarin SK, Kumar A, Angus PW, Saran Baijal S, Soon Koo B, Bayraktar Y, et al. Diagnosis and management of acute variceal bleeding: Asian Pacific Association for Study of the Liver recommendations. Hepatol Int [Internet]. 2011 [cited 28/11/2017]; 5(2):607-624. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PM C3090560/

  9. De Franchis R. Expanding consensus in portal hypertension: report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol [Internet]. 2015 [cited 28/11/2017]; 63(3):743–52. Available from : https://www.journal-ofhepatology. eu/article/S0168-8278(15)00349- 9/pdf

  10. Tripathi D, Stanley AJ, Hayes PC. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut [Internet].2015 [cited 27/10/2017] ; 64(11):1680-704. Available from : https://www.ncbi.nlm.nih.gov/pubmed/258873 80

  11. Kumar Amith S, Sibia Raminderpal S. Predictors of In-hospital Mortality among patients presenting with variceal gastrointestinal bleeding. Saudi J Gastroenterology [Internet]. Jan-Feb 2015 [cited 27/10/2017]; 21(1):43-46. Available from : https://www.ncbi.nlm.nih.gov/pmc/articles/PM C4355862/

  12. Fortune B, García-Tsao G. Current management strategies for acute esophageal variceal hemorrhage. Curr Hepatol Rep 2014 [cited 27/11/2017];13(1):35-42. Available from : https://www.ncbi.nlm.nih.gov/pmc/articles/PM C4061703/

  13. García Pagán JC, Barrufet M, Cárdenas A. Management of gastric varices. Clin Gastroenterol Hepatol [Internet]. 2014 [cited 27/11/2017]; 12:919-28. Available from: https://www.ncbi.nlm.nih.gov/pubmed/201961 20

  14. Abreu Jarrín M, Ramos Tirado S, Trejo Muñoz N, Cintado Tortoló D. Caracterización clínico-endoscópica de pacientes con hemorragia digestiva alta. Hospital General Pedro Betancourt de Jovellanos. Rev. Med. Electrón [Internet]. 2013 Abr [citado 19/01/2018]; 35(2):134-143. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext &pid=S1684-18242013000200005&lng=es.

  15. Mosqueira Jorge R, Montiel Johana B, Rodríguez D, Monge E. Evaluación del Test Diagnóstico índice número de plaquetas / diámetro mayor del bazo, como predictor de la presencia de várices esofágicas en cirrosis hepática. Rev. gastroenterol. Perú [Internet]. 2011 Ene [citado 16/05/2018]; 31(1):11-16. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_ arttext&pid=S1022- 51292011000100003&lng=es.

  16. Bustíos C, Dávalos M, Román R, Zumaeta E. Características Epidemiológicas y Clínicas de la Cirrosis Hepática en la Unidad de Hígado del HNERM Es-Salud .Rev. gastroenterol. Perú [Internet]. 2007 Jul [citado 16/05/2018]; 27(3):238-245. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_ arttext&pid=S1022- 51292007000300003&lng=es.

  17. Xiao-Dong Shao, Xing-Shun Qi, and Xiao- Zhong Guo. Esophageal Stent for Refractory Variceal Bleeding: A Systemic Review and Meta- Analysis. BioMed Research International [Internet]. 2016 [citado 27/08/2017]; 45:10. Disponible en: http://dx.doi.org/10.1155/2016/4054513

  18. Lo GH, Lai KH, Cheng JS, Chen MH, Chiang HT. A prospective, randomized trial of butyl cyanoacrylate injection vs band ligation in the management of bleeding gastric varices. Hepatology [Internet]. . 2001[cited 27/08/2017]; 33(5):1060-4. Available from : https://aasldpubs.onlinelibrary.wiley.com/doi/p df/10.1053/jhep.2001.24116

  19. González Salomo E, González Torres MF, Méndez Catasús R. Sangramiento por várices esofagogástricas en hospitales de Ciudad de La Habana. Rev Cub Med Mil [Internet]. Jun 1997 [citado 19/01/2018]; 26(1):8-13. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext &pid=S0138-65571997000100001&lng=es.

  20. Parrochia E, Soto JR, Guerra ME. Panendoscopía y hemorragia digestiva alta. Bol Hosp San Juan de Dios. 2006; 33(5):313-9.

  21. Zumaeta Villena E. Várices esofagogástricas. Acta Méd. Peruana [Internet]. 2007 [citado 19/01/2018]; 24(1):47-52. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_ arttext&pid=S1728- 59172007000100011&lng=es.

  22. Orloff MJ, Isenberg JI, Wheeler HO, Haines KS, Jinich-Brook H, Rapier R, et al. Emergency portacaval shunt vs rescue portacaval shunt in a randomized controlled trial of emergency treatment of acutely bleeding esophageal varices. J Gastrointest Surg [Internet]. 2010 [cited 17/01/2018]; 14: 1782-95. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PM C2956038/pdf/11605_2010_Article_1279.pdf

  23. Berreta, J, Kociak, D, Corti, R, Morales, G, Ortiz, M, Laplacette, M, Bellido, F, Romero, G, Salgado, P, Tumilasci, O. Predictores de mortalidad hospitalaria en la hemorragia digestiva alta variceal por hepatopatía crónica tratada endoscópicamente. Acta Gastroenterológica Latinoamericana [Internet]. 2008 [citado 17/01/2018]; 38(1):43-50. Disponible en: http://www.redalyc.org/articulo.oa?id=1993180 17008

  24. Augustin S, Altamirano J, González A, Dot J, Abu Suboh M, Armengol JR, et al. Effectiveness of combined pharmacologic and ligation therapy in high-risk patients with acute esophageal variceal bleeding. Am J Gastroenterol. [Internet]. 2011 [cited 17/01/2018]; 106(10):1787-95. Available from : https://www.nature.com/articles/ajg2011173

  25. Rodríguez Hernández H, Guerrero Romero JF, Jacobo K, Janett S, Rodríguez Morán M. Análisis de supervivencia en pacientes cirróticos. Rev Gastroenterol Méx. 2006;61(3):226-32




2020     |     www.medigraphic.com