Improved survival after variceal hemorrhage over an 11-year period in the Department of Veterans Affairs.
Improved survival after variceal hemorrhage over an 11-year period in the Department of Veterans Affairs.
复制标题
退伍军人事务部 11 年来提高了静脉曲张出血后的生存率。
DOI：
10.1016/s0002-9270(00)02169-9
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发表时间：
2000
期刊：
影响因子：
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通讯作者：
J. Everhart
中科院分区：
文献类型：
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作者：
H. El‐Serag;J. Everhart
结论：在过去的二十年中，几种方法已被广泛用于食管静脉曲张出血的治疗。这些措施对这种类型的出血患者的结果的有效性仍然unknowed.METHODS：使用退伍军人事务部（VA）患者治疗文件，我们确定了两个队列的患者诊断为初始静脉曲张出血：早期队列在1981-1982年（1339例患者），和晚期队列在1988-1991年（3636例患者）。每个队列随访6年，观察再出血和死亡情况。结果：晚期队列患者年龄较大（57岁vs 55岁，p< 0.0001），腹水较多（25% vs 13%，p <0.0001），腹膜炎较多（4% vs 2%，p <0.0001），脑病较多（14% vs 9%，p= 0.0003）。晚期队列在30天（20.8% vs 29.6%，p= 0.0001）和6年（69.7% vs 74.5%，p= 0.0001）时的死亡率显著下降。当控制晚期队列中更严重的疾病时，多变量生存分析强调了这种改善。对于前30天存活的患者，单变量分析发现早期队列（63.7%）和晚期队列（61.8%）之间的6年死亡率无显著差异（p= 0.25），但多变量分析发现晚期队列的生存率略好（p= 0.01）。在晚期队列中，在最初住院期间接受硬化治疗的患者有更好的30天（17%）和6年死亡率（68%）比其余的晚期coherent.CONCLUSIONS：在1981-1982年和1988-1991年之间，食管静脉曲张出血首次发作后的长期生存率的改善主要是由于更好的短期死亡率。硬化疗法为提高生存率提供了部分解释。
OBJECTIVES:Over the past two decades, several modalities have become widely used in the management of esophageal variceal hemorrhage. The effectiveness of these measures on the outcome of patients with this type of hemorrhage remains unknown.METHODS:Using the Department of Veterans Affairs (VA) Patient Treatment File, we identified two cohorts of patients diagnosed with an initial variceal hemorrhage: an early cohort during 1981–1982 (1339 patients), and a late cohort during 1988–1991 (3636 patients). Each cohort was followed for 6 yr for rebleeding and death. Analyses were performed with proportional hazards survival analysis controlling for confounding factors.RESULTS:On presentation, patients in the late cohort were older (57 yr vs 55 yr, p< 0.0001) and had more ascites (25% vs 13%, p< 0.0001), more peritonitis (4% vs 2%, p< 0.0001), and more encephalopathy (14% vs 9%, p= 0.0003). The late cohort experienced a significant decline in mortality at 30 days (20.8% vs 29.6%, p= 0.0001) and at 6 yr (69.7% vs 74.5%, p= 0.0001). This improvement was accentuated in multivariate survival analysis when controlling for the more severe illness in the late cohort. For patients who survived the first 30 days, no significant difference in 6-yr mortality was found on univariate analysis between the early cohort (63.7%) and late cohort (61.8%)(p= 0.25), but survival was slightly better in the late cohort on multivariate analysis (p= 0.01). In the late cohort, patients with sclerotherapy during the initial hospitalization had better 30-day (17%) and 6-yr mortality (68%) than did the rest of the late cohort.CONCLUSIONS:Between the years 1981–1982 and 1988–1991, improvements in long-term survival after an initial episode of esophageal variceal hemorrhage resulted primarily from better short-term mortality. Sclerotherapy offers a partial explanation for improved survival.