High doses of β-blockers and alcohol abstinence improve long-term rebleeding andmortality in cirrhotic patients after an acute variceal bleeding

Background & aim: We analysed prognostic indicators of long-term outcome in cirrhotic patients surviving the critical 6-week period after an episode of acute variceal bleeding. Methods: All patients with oesophageal variceal bleeding from 2001-2007 were prospectively registered. Follow-up extended from day 42 after index bleeding to last visit, death or liver transplantation (LT). Multivariate Cox regression analysis was performed. Results: Two hundred and fifty variceal bleeding episodes were registered. Fifty-four patients (26%) died before day 42, and 123 patients were finally included. Median follow-up was 23.5 months. Nadolol±nitrates alone or combined with variceal ligation were used as prophylaxis in 93% of patients. During follow-up, 43 patients (35%) experienced rebleeding, 34 (27.5%) died and 10 (8%) were transplanted. Follow-up β-blocker dose (HR 0.993, 95% CI 0.987-0.998, P = 0.027) and alcohol abstinence (HR 0.324, 95% CI 0.152-0.691, P = 0.004) were independent rebleeding predictors. The Cox analysis disclosed the Child-Pugh score (HR 1.24, 95% CI 1.08-1.43, P = 0.002), creatinine (HR 1.82, 95% CI 1.17-2.82, P = 0.008), β-blocker dose (HR 0.992, 95% CI 0.987-0.997, P = 0.003), viral cirrhosis (HR 2.72, 95% CI 1.31-5.67, P = 0.008), hepatocellular carcinoma (HR 9.44, 95% CI 3.54-25.20, Po0.001) and alcohol abstinence (HR 0.29, 95% CI 0.13-0.62, P = 0.002) to be independent prognostic markers for mortality/LT. Conclusion: High doses of β-blockers and alcohol abstinence decrease rebleeding and mortality in cirrhotic patients surviving the 6-week period after acute variceal bleeding. © 2010 John Wiley & Sons A/S.