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Cox analysis of predictive variables for first bleeding and survival in cirrhotic patients with large varices
194
cox A N A L Y S I S OF P R E D I C T I V E V A R I A B L E S FOR F I R S T B L E E D I N G AND S U R V I V ~ L N C I R R H O T I C P A T I E N T S WITH LARGE VARICES. P. Cal~s CHU Purpan, T o u l o u s e and a m u l t i c e n t e r group study, France.
In cirrhotic p a t i e n t s w i t h o u t p a s t h i s t o r y of d i g e s t i v e bleeding, the risk factors for b l e e d i n g and d e a t h were only studied in r e t r o s p e c t i v e series. We had the o p p o r t u n i t y to follow p r o s p e c t i v e l y 104 cirrhotic ( 9 1 % alcoholic) patients with esophageal varices (EV), w i t h o u t p a s t h i s t o r y of b l e e d i n g and a C h i l d - P u g h score b e l o w 14 d u r i n g a mean follow up of 13 months. P a t i e n t s w e r e r e v i e w e d every 3 months. F o l l o w i n g p o t e n t i a l p r o g n o s t i c factors w e r e s t u d i e d a c c o r d i n g to the Cox model : age, cause of cirrhosis, ascites, encephalopathy, alcohol withdrawal, C h i l d - P u g h score, EV size (2 classes : m e d i u m and large size), mean a r t e r i a l pressure, creatinine, p l a s m a Na, p r o t h r o m b i n time, albumin, platelet, GGT and ASAT. Results : At the end of the study 27 % of p a t i e n t s have bled (of w h o m 60 % died) and a total of 36 % w e r e dead. The risk of first b l e e d i n g was p o s i t i v e l y correlated w i t h the size of varices and n e g a t i v e l y c o r r e l a t e d with the age of patients. (p<0.05). The risk of b l e e d i n g was 22 % w i t h m e d i u m sized E V and 44 % with large size EV (p<0.05). C h i l d - P u g h score and p l a s m a Na w e r e the o n l y s i g n i f i c a n t i n d e p e n d e n t risk factors for death (p{0.05) . The risk of d e a t h a c c o r d i n g to C h i l d - P u g h grade was : grade A ; 12%, grade B : 32%, grade C : 50% (p(0.01). C o n c l u s i o n : In p a t i e n t s with cirrhosis, EV and no p r e v i o u s digestive bleeding, the risk of b l e e d i n g was g r e a t h e r in y o u n g e s t p a t i e n t s w i t h large varices and the risk of death w a s d e p e n d e n t of the severity of liver disease.
195
E F F E C T S OF P R O P R A N O L O L ON N E U R O P S Y C H O L O G I C A L FUNCTIONS AND C E R E B R A L BLOOD FLOW IN CIRRHOSIS. P. Cal~s, M. Pierre-Nicolas, A. Guell, J.P. Caucanas, J.P. Vinel, J.P. Pascal CHU Purpan, Toulouse, France.
In p a t i e n t s w i t h cirrhosis, it has b e e n suggested that p r o p r a n o l o l could lead to encephalopathy. Several m e c h a n i s m s have been suggested, in p a r t i c u l a r : increase in b l o o d ammonia, or d e c r e a s e in cerebral b l o o d flow. The aim of this study was to assess the effects of p r o p r a n o l o l on cerebral h a e m o d y n a m i c s and n e u r o p s y c h o l o g i c a l functions. Methods : 16 p a t i e n t s with alcoholic cirrhosis, o e s o p h a g e a l varices and w i t h o u t major hepatic d y s f u n c t i o n (Child-Pugh score (CP)
$103
cox A N A L Y S I S OF P R E D I C T I V E V A R I A B L E S FOR F I R S T B L E E D I N G AND S U R V I V ~ L N C I R R H O T I C P A T I E N T S WITH LARGE VARICES. P. Cal~s CHU Purpan, T o u l o u s e and a m u l t i c e n t e r group study, France.
In cirrhotic p a t i e n t s w i t h o u t p a s t h i s t o r y of d i g e s t i v e bleeding, the risk factors for b l e e d i n g and d e a t h were only studied in r e t r o s p e c t i v e series. We had the o p p o r t u n i t y to follow p r o s p e c t i v e l y 104 cirrhotic ( 9 1 % alcoholic) patients with esophageal varices (EV), w i t h o u t p a s t h i s t o r y of b l e e d i n g and a C h i l d - P u g h score b e l o w 14 d u r i n g a mean follow up of 13 months. P a t i e n t s w e r e r e v i e w e d every 3 months. F o l l o w i n g p o t e n t i a l p r o g n o s t i c factors w e r e s t u d i e d a c c o r d i n g to the Cox model : age, cause of cirrhosis, ascites, encephalopathy, alcohol withdrawal, C h i l d - P u g h score, EV size (2 classes : m e d i u m and large size), mean a r t e r i a l pressure, creatinine, p l a s m a Na, p r o t h r o m b i n time, albumin, platelet, GGT and ASAT. Results : At the end of the study 27 % of p a t i e n t s have bled (of w h o m 60 % died) and a total of 36 % w e r e dead. The risk of first b l e e d i n g was p o s i t i v e l y correlated w i t h the size of varices and n e g a t i v e l y c o r r e l a t e d with the age of patients. (p<0.05). The risk of b l e e d i n g was 22 % w i t h m e d i u m sized E V and 44 % with large size EV (p<0.05). C h i l d - P u g h score and p l a s m a Na w e r e the o n l y s i g n i f i c a n t i n d e p e n d e n t risk factors for death (p{0.05) . The risk of d e a t h a c c o r d i n g to C h i l d - P u g h grade was : grade A ; 12%, grade B : 32%, grade C : 50% (p(0.01). C o n c l u s i o n : In p a t i e n t s with cirrhosis, EV and no p r e v i o u s digestive bleeding, the risk of b l e e d i n g was g r e a t h e r in y o u n g e s t p a t i e n t s w i t h large varices and the risk of death w a s d e p e n d e n t of the severity of liver disease.
195
E F F E C T S OF P R O P R A N O L O L ON N E U R O P S Y C H O L O G I C A L FUNCTIONS AND C E R E B R A L BLOOD FLOW IN CIRRHOSIS. P. Cal~s, M. Pierre-Nicolas, A. Guell, J.P. Caucanas, J.P. Vinel, J.P. Pascal CHU Purpan, Toulouse, France.
In p a t i e n t s w i t h cirrhosis, it has b e e n suggested that p r o p r a n o l o l could lead to encephalopathy. Several m e c h a n i s m s have been suggested, in p a r t i c u l a r : increase in b l o o d ammonia, or d e c r e a s e in cerebral b l o o d flow. The aim of this study was to assess the effects of p r o p r a n o l o l on cerebral h a e m o d y n a m i c s and n e u r o p s y c h o l o g i c a l functions. Methods : 16 p a t i e n t s with alcoholic cirrhosis, o e s o p h a g e a l varices and w i t h o u t major hepatic d y s f u n c t i o n (Child-Pugh score (CP)
$103