Liver, Pancreas, and Biliary TractPrognostic value of early measurements of portal pressure in acute variceal bleeding☆,☆☆
Section snippets
Patients and methods
Cirrhotic patients who were admitted to our unit because of acute variceal bleeding from February 1996 to August 1997 were asked to participate in this study after an endoscopic diagnosis of variceal bleeding. The study protocol was approved by the ethics committee of the hospital clinic and was in accordance with the Helsinki Declaration of 1975, as revised in 1983. All patients gave written, informed consent for participation in the study.
The variceal bleeding of the cirrhotic patients was
Results
During the study, 99 eligible patients were admitted to the intensive care unit (ICU) of the liver unit because of acute variceal bleeding. Sixty-five patients were included to the study. Reasons for exlusion were lack of consent for 14 patients, inability to schedule the hemodynamic study within 48 hours from admission for 14 patients, and exsanguinating bleeding in 6 patients (4 of whom died and 2 required emergency surgery within the first 24 hours).
Of the 65 included patients, 36 patients
Discussion
This study was aimed at testing the hypothesis that early measurement of portal pressure can provide useful prognostic information in cirrhotic patients admitted because of acute variceal bleeding. The rationale was that previous retrospective studies had suggested such a relationship.9, 10 Also, we made the assumption that variceal bleeding, the main complication of portal hypertension, is likely to be worse in patients with greater portal pressure elevations. Actually, the increase in portal
Acknowledgements
The authors thank Diana Bird for secretarial support; Angeles Baringo, Laura Rocabert, and Rosa Sáez for expert technical assistance; and the Liver Intensive Care Unit nursing staff.
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Address requests for reprints to: Jaime Bosch, M.D., Liver Unit, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain. e-mail: [email protected]; fax: (34) 934-515-522.
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Supported in part by grant FIS 97/1309 from the Fondo de Investigación Sanitaria. Dr. Moitinho was supported by grants FIS 97/5617 and FIS 98/9470 from the Hospital Clinic and from Fondo de Investigación Sanitaria.