Predictive Factors for Rebleeding and Death in Alcoholic Cirrhotic Patients with Acute Variceal Bleeding: A Multivariate Analysis Jake E. J. Krige Æ Urda K. Kotze Æ Greg Distiller Æ John M. Shaw Æ Philippus C. Bornman Published online: 13 August 2009 Ó Socie ´te ´ Internationale de Chirurgie 2009 Abstract Background Bleeding from esophageal varices is a leading cause of death in alcoholic cirrhotic patients. The aim of the present single-center study was to identify risk factors predictive of variceal rebleeding and death within 6 weeks of initial treatment. Methods Univariate and multivariate analyses were per- formed on 310 prospectively documented alcoholic cir- rhotic patients with acute variceal hemorrhage (AVH) who underwent 786 endoscopic variceal injection treatments between January 1984 and December 2006. All injections were administered during the first 6 weeks after the patients were treated for their first variceal bleed. Results Seventy-five (24.2%) patients experienced a re- bleed, 38 within 5 days of the initial treatment and 37 within 6 weeks of their initial treatment. Of the 15 vari- ables studied and included in a multivariate analysis using a logistic regression model, a bilirubin level [ 51 mmol/l and transfusion of [ 6 units of blood during the initial hospital admission were predictors of variceal rebleeding within the first 6 weeks. Seventy-seven (24.8%) patients died, 29 (9.3%) within 5 days and 48 (15.4%) between 6 and 42 days after the initial treatment. Stepwise multivar- iate logistic regression analysis showed that six variables were predictors of death within the first 6 weeks: enceph- alopathy, ascites, bilirubin level [ 51 mmol/l, international normalized ratio (INR) [ 2.3, albumin \ 25 g/l, and the need for balloon tube tamponade. Conclusions Survival was influenced by the severity of liver failure, with most deaths occurring in Child-Pugh grade C patients. Patients with AVH and encephalopathy, ascites, bilirubin levels [ 51 mmol/l, INR [ 2.3, albumin \ 25 g/l and who require balloon tube tamponade are at increased risk of dying within the first 6 weeks. Bilirubin levels [ 51 mmol/l and transfusion of [ 6 units of blood were predictors of variceal rebleeding. Introduction Bleeding from esophageal varices is the most serious complication of portal hypertension and accounts for most cirrhosis-related deaths [1]. One quarter of cirrhotic patients who present with a major first variceal bleed die as a consequence of the bleed [2]. Endoscopic control of bleeding is the emergency treatment of choice if actively bleeding esophageal varices are present [3, 4]. Although advances in treatment have reduced overall mortality [5, 6], uncontrolled and recurrent bleeding from varices and the consequences of progressive liver failure remain the com- monest causes of early death in alcoholic cirrhotic patients [7]. The rational treatment of esophageal varices requires a clear understanding of the risks of rebleeding, the hazards J. E. J. Krige (&) Á U. K. Kotze Á J. M. Shaw Á P. C. Bornman Department of Surgery J45OMB, Groote Schuur Hospital, Anzio Road, Observatory 7925, Cape Town, South Africa e-mail: jej.krige@uct.ac.za J. E. J. Krige Á J. M. Shaw Á P. C. Bornman MRC Liver Research Center, Groote Schuur Hospital, Anzio Road, Observatory 7925, Cape Town, South Africa J. E. J. Krige Á U. K. Kotze Á J. M. Shaw Á P. C. Bornman University of Cape Town Health Sciences Faculty and Surgical Gastroenterology Unit, Groote Schuur Hospital, Anzio Road, Observatory 7925, Cape Town, South Africa G. Distiller Department of Statistics, University of Cape Town, Rondebosch 7701, Cape Town, South Africa 123 World J Surg (2009) 33:2127–2135 DOI 10.1007/s00268-009-0172-6