Objectives: Bleeding from gastroesophageal varices is the most serious and life-threatening complication of cirrhosis and accounts for 10% of all cases of bleeding from the upper gastrointestinal tract. It is essential to identify and treat those patients at the highest risk because each episode of variceal hemorrhage carries a 20% to 30% risk of death, and up to 70% of patients who do not receive treatment die within one year of the initial bleeding episode. The aim of this study was to determine the clinical predictors of bleeding esophageal varices and to examine the role of factor VII and von Willebrand factor (vWF) in predicting bleeding in patients with esophageal varices.
Methods: The study included all patients with esophageal varices admitted to Sohag and Qena university hospitals from January 2012 to August 2013 who consented to participate in the study. Various clinical, laboratory and endoscopic variables were tested to determine the predictors of esophageal bleeding.
Results: Among 300 patients with esophageal varices, 80% were due to hepatitis C virus (HCV), 18% due to hepatitis B virus (HBV), and 2% were due to both HCV and HBV infection as etiologic factors for their liver disease. Blood hemoglobin was 10.12 ± 2.26 g/l, platelet count 135.55 ± 65.94 × l09/l, prothrombin time 14.1 ± 0.92 seconds, albumin 2.88 ± 0.71 g/dl, ALT 48.25 ± 24.15 u/l, total bilirubin 1.92 ± 1.36 mg/dl. Factor VII was 27.4 ± 8.92 percent and vWF was 188.33 ± 13.66 iu/dl. Splenomegaly was reported in 79.6%, ascites in 90.3% o patients. On esophagogastroduodenoscopy (EGD) 35% of patients had grade III esophageal varices, 29% had four-column esophageal varices, 13.7% had concomitant gastric varices and 38.3% had portal hypertensive gastropathy.
Platelet count, presence of red color signs, the number of columns of esophageal varices, presence of portal hypertensive gastropathy on EGD showed a significant positive correlation with bleeding. In addition, there was a significant decrease of factor VII and a significant increase of vWF in the bleeding group in comparison with the non-bleeding group.
Conclusion: Thrombocytopenia, presence of encephalopathy and endoscopic findings of large varices, presence of red color sign, and portal hypertensive gastropathy were found to be predictors of esophageal variceal bleeding. Increase of vWF and decrease of FVII are laboratory predictors of esophageal variceal bleeding.