An international multicenter analysis of the outcome of pediatric first variceal hemorrhage.
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Shneider Benjamin L, Gao Xiaotian, Guo Kexin, Jaramillo Catalina, Molleston Jean P, Pimenta Julio, Superina Riccardo, Ferreira Alexandre, Gumm Alexis J, Aqul Amal, Feldman Amy G, Di Giorgio Angelo, Pai Anita K, Novak Anja Praprotnik, Gardin Antoine, Jimenez-Rivera Carolina, Amaro-Reynoso César Ulises, Desai Chaitri, Voroniak Dariia, Aldrian Denise, Bannister Elizabeth, Shteyer Eyal, Vogel Georg F, Indolfi Giuseppe, van der Doef Hubert P J, Squires James E, Hartley Jane L, Gana J C, Quintero-Bernabéu Jesus, Taylor Jordache, Sweeny Katherine, Chew Kee-Seang, Hazleton Keith Z, Bass Lee M, Mercadal-Hally Maria, Durilova Marianna, Homan Matjaž, Martinez Mercedes, Kehar Mohit, Kasahara Mureo, Godik Oleg, Waisbourd-Zinman Orith, Valentino Pamela L, Spector Pooja R, Fawaz Rima, Vázquez-Frias Rodrigo, Yuldashev Rustam, Komine Ryuji, Kulkarni Sakil, Ibrahim Samar H, Bedoyan Sarah, Smith Sara Kathryn, Elisofon Scott A, Lam Simon, Yokoyama Shinya, Carrera Simona, Getsuwan Songpon, Treepongkaruna Suporn, Berkenfeld Sarah, Kotsou Thomai, Goldman Deborah, Slowik Voytek, Lee Way-Seah, Karnsakul Wikrom, Hardikar Winita, Mozer-Glassberg Yael, De Franchis Roberto, Ackermann Oanez, Grammatikopoulos Tassos
Аннотация
APPROACH RESULTS: Center-specific characteristics and approaches to portal hypertension were determined at 44 international sites. K-means clustered the centers based upon volume and complexity of approaches [cluster 1 high (n=5), cluster 2 low (n=21), cluster 3 intermediate (n=18]). Clinical features and outcomes after 1VH were available from 345 subjects. Factors associated with overall survival (OS) and survival with native liver (SNL) were estimated by Kaplan-Meier survival curves, log rank tests, univariable and multivariable Cox regression models. OS and SNL were high in portal vein thrombosis and noncirrhotic diseases and significantly higher than biliary atresia and cirrhotic diseases (p<.001). Diminished SNL was observed in decompensated disease [diuretics (i.e. ascites) or hospitalization at 1VH], biliary atresia with poor bile flow, cirrhotic disease, after sclerotherapy or no endoscopic intervention. Diminished OS was noted in those with cirrhosis or requiring sclerotherapy. 6-week mortality was determined and compared among clusters using average treatment effect under the Rubin causal model. Overall 6-week mortality was 4.1%, 1.4% in nonhospitalized subjects and was significantly higher in cluster 2 versus 1 centers (P=.010).
CONCLUSIONS: Immediate mortality after 1VH in children is low compared to adults. Outcomes after 1VH are diagnosis-specific and worse in decompensated disease and after sclerotherapy. Center-specific factors may influence immediate outcomes after 1VH.