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Characterization of gastrointestinal hemorrhage and prediction of mortality in Asian patients with alcoholic hepatitis

Title
Characterization of gastrointestinal hemorrhage and prediction of mortality in Asian patients with alcoholic hepatitis
Authors
Kim, Su HwanKim, Byeong GwanKim, WonOh, SoheeKim, Hwi YoungJung, Yong JinJeong, Ji BongKim, Ji WonLee, Kook Lae
Ewha Authors
김휘영
SCOPUS Author ID
김휘영scopus
Issue Date
2016
Journal Title
JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY
ISSN
0815-9319JCR Link

1440-1746JCR Link
Citation
JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY vol. 31, no. 4, pp. 814 - 821
Keywords
gastrointestinal hemorrhageMaddrey's discriminant functionmodel for end-stage liver diseasemortalityportal hypertension
Publisher
WILEY
Indexed
SCIE; SCOPUS WOS
Document Type
Article
Abstract
Background and Aim:Gastrointestinal bleeding (GIB) often accompanies alcoholic hepatitis (AH). The study aimed to investigate clinical characteristics of GIB in AH patients and to identify risk factors for mortality in AH patients with GIB. Methods:Data from 329 patients hospitalized with AH in a single center during 1999-2014 were retrospectively analyzed. Patients with AH were dichotomized into GIB and non-GIB groups. The GIB group was further divided into portal hypertensive bleeding (PHB) and non-PHB groups. Clinical characteristics and survival outcomes were compared between the groups. Risk factors for mortality were analyzed using Cox regression. Results:Among the 329 AH patients, 132 experienced GIB at admission or during hospitalization. The most common cause of GIB was an esophageal varix. The GIB group had worse survival outcomes than the non-GIB group (log-rank test, P=0.034). The PHB group had worse survival outcomes than the non-PHB group (log-rank test, P=0.001). On multivariate analysis, alcohol consumption, ascites, encephalopathy, infection, Maddrey's discriminant function, and the model for end-stage liver disease (MELD) score independently predicted mortality in the entire AH cohort. The MELD score (hazard ratio, 1.085; 95% confidence interval, 1.052-1.120; P<0.001) and PHB (hazard ratio, 2.162; 95% confidence interval, 1.021-4.577; P=0.044) were significant prognosticators for patients with AH and GIB. Conclusions:The presence of PHB and a higher MELD score adversely affected survival in AH patients with GIB. Accordingly, prompt endoscopic examination for exploring the etiologies of GIB may alert physicians to predict the risk of death in AH patients with GIB.
DOI
10.1111/jgh.13220
Appears in Collections:
의과대학 > 의학과 > Journal papers
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