The Predictive Function Of Hepatic Venous Press Gradient(HVPG) For Early Bleeding After Endoscopic Variceal Ligation (EVL)

Objective:Esophageal variceal bleeding (EVL) is one of the severe complications of portal hypertension with humorous hemorrhage and high mortality, and portal hypertension is the consequence of liver cirrhosis. Endoscopic variceal ligation is the first choice to prevent and treat the variceal bleeding but it also has a high rebleeding rate and a considerable mortality. However, there are little studies to analyze the possible factors that influence the rebleeding after EVL, especially the correlation of hepatic venous pressure gradient (HVPG) and rebleeding after EVL. Our study will analyze the possible factors influencing the rbleeding after EVL, especially the relationship of HVPG and rebleeding after EVL to investigate the predictive function of HVPG.Materials and Method:Retrospectively analyze the patients’medical records of diagnosis and treatment which have a HVPG measurement before the EVL from Shandong Provincial Hospital of Eastern Hospital Gastroenterology Department period from October2010to March2014. Collected their HVPG value, etiology, previous history of bleeding, previous history of ligation, surgery and related treatment history, blood Routine, Coagulation indicators, liver function gradient, biochemical indicators, ascites, hepatic encephalopathy and other complications occurred, as well as endoscopic findings and other relevant data such as Red sign, ligation number, and followed up of the105patients whether bleeding and whether serious complications or death situation2weeks after the ligation. And then we carried out the following two statistic work by SPSS16:Dividing the patients into two groups according to whether bleeding during2weeks after ligation, and then applicating the Wilcoxon test chi-square test and to analyze individual factors, whether there is a statistically significance, and applicating the logistic regression model for multivariate analysis to draw relevant factors risk and find a HVPG predictable indicators. And using ROC analysis to observed the predictive value of HVPG, and find its sensitivity and specificity when HVPG.≥16mmHg.Result:After serious exclusion there are105patients included in our study with complete information. According to the follow-up, bleeding group have11patients(10.47%), non-bleeding group have94patients (89.52%).It was significant deviation between2groups in PT (P=0.031), INR (P=0.030), liver Child-Pugh classification (P=0.005), ALT(P=0.047), HVPG (P=0.006), whereas there was no significant in the left factors. According to ROC analysis, the area under the curve of HVPG about early bleeding after EVL is0.866, when HVPG≥16mmHg, it was significantly different in the occurrence of bleeding and not bleeding(P<0.001) and the area under the curve is the largest (0.838), with a sensitivity of90.9%, specificity of76.6%,There was statistically significant in predicting early bleeding after EVL.Conclusion:Early bleeding after EVL was associated with HVPG, ALT, PT, INR and liver function Child-Pugh classification. Among these factors HVPG is the only independent factor affecting early rebleeding after EVL, the cut-off of HVPG≥16mmHg can predicte early bleeding after EVL with a certain accuracy, a high sensitivity and specificity.