Retrospective Cohort Study
Copyright ©The Author(s) 2022.
World J Hepatol. Aug 27, 2022; 14(8): 1584-1597
Published online Aug 27, 2022. doi: 10.4254/wjh.v14.i8.1584
Table 1 Baseline characteristics of patients with cirrhosis requiring balloon tamponade for acute severe variceal bleeding comparing death and survival at 6 wk
Variable (n = 75)
Survived (n = 40)
Death (n = 35)
P value
Male sex30 (75.0)28 (80.0)0.783
Age in years58 (48, 65)54 (49, 65)0.629
Cirrhosis aetiology: Alcoholic liver disease, Chronic viral hepatitis, NASH26 (65.0), 16 (40.0), 6 (15.0)28 (80.0), 14 (40.0), 1 (2.9)0.199, 1.00, 0.113
Child-Pugh score 8 (7, 10)11 (8, 12)0.004
MELD score 14 (11, 18)19 (16, 24)< 0.001
AIMS65 score2 (1, 2.5)3 (2, 3)0.004
Glasgow-Blatchford score12 (9, 14)12 (9, 15)0.908
Complete Rockall score8 (7, 8)8 (7, 8)0.159
HCC 2 (5.0)9 (25.7)0.019
Portal vein thrombosis6 (15.0)4 (11.4)0.742
Antiplatelets or anticoagulants 7 (17.5)2 (5.7)0.162
Glasgow Coma Scale 15 (14, 15)15 (14, 15)0.503
Systolic blood pressure 101 (91, 123)96 (76, 124)0.328
Heart rate 95 (82, 114)104 (91, 118)0.304
Significant hypoxia (FiO2 > 35%)10 (25.0)13 (37.1)0.319
Haemoglobin g/L 86 (74, 103)78 (63, 111)0.538
Platelets × 109/L 96 (72, 123)110 (75, 150)0.204
Albumin g/L 26 (22, 28)22 (19, 28)0.034
INR 1.5 (1.3, 1.7)1.9 (1.5, 2.3)< 0.001
Bilirubin μmol/L 29 (14, 54)51 (29, 119)0.003
Serum sodium mmol/L 139 (135, 141)135 (129, 140)0.025
Serum creatinine μmol/L74 (62, 92)95 (73, 124)0.014
Serum pH 7.36 (7.26, 7.44)7.30 (7.10, 7.41)0.072
Lactate mmol/L 3.10 (1.65, 5.35)5.20 (2.65, 9.80)0.007
Table 2 Management of index variceal bleed and characteristics around insertion of Sengstaken-Blakemore tube
Variable
Value (n = 80)
Vasoactive agent79 (98.8)
Terlipressin30 (37.5)
Octreotide49 (61.3
Empiric antibiotics77 (96.3)
Time to endoscopy from bleed, h6.8 (4.2, 19.0)
Site of variceal bleed
Oesophageal varices64 (80.0)
Gastric varices16 (20.0)
Initial endoscopic therapy
Variceal band ligation43 (53.8)
Cyanoacrylate injection2 (2.5)
Indication for SBT insertion
Incomplete haemostasis54 (67.5)
Poor endoscopic views41 (51.2)
Approach for SBT insertion (n = 71)
Nasal22 (31.0)
Oral49 (69.0)
Confirmation of SBT position
X-ray44 (55.0)
Direct endoscopic vision18 (22.5)
No documentation15 (18.8)
Gastric balloon inflation (n = 76)
Volume, mL285 (250, 300)
Time inflated, h26.8 (16.9, 44.7)
Oesophageal balloon inflation (n = 22)
Volume, mL100 (39, 100)
Time inflated, h20.5 (10.2, 36.8)
Therapy post-SBT deflation (n = 62)
Repeat endoscopic therapy27 (43.5)
Further balloon tamponade16 (20.0)
Table 3 Patient outcomes following Sengstaken-Blakemore Tube insertion
Variable
Value (n = 80)
Length of stay, d
Total hospital LOS11.0 (7.0, 19.5)
ICU LOS4.90 (2.3, 9.1)
Duration of mechanical ventilation, h89.5 (39.3, 153.8)
Blood product transfusion
Packed red cells, units6 (4, 10)
Platelets, units1 (0, 3)
Fresh frozen plasma, units2 (1, 6)
Achieved primary haemostasis73 (91.3)
Re-bleeding25 (34.2)
Complications of SBT19 (34.5)
Mucosal ulceration and tears (without perforation)17 (89.5)
Aspiration pneumonia4 (21.0)
Perforation1 (5.3)
TIPS
Underwent TIPS17 (21.3)
Time to TIPS from SBT, d2.95 (1.4, 4.1)
Survival
Survived hospital admission41 (51.2)
Alive at 6 wk41 (51.2)
Alive at 26 wk39 (48.8)
Alive at 52 wk37 (46.3)
Table 4 Predictors of 6 wk mortality after acute severe variceal bleeding requiring balloon tamponade
Variable (n = 75)
Univariate analysis

Multivariate analysis (n = 68)


OR (95%CI)
P value
OR (95%CI)
P value
Age0.99 (0.95-1.04)0.669--
Male sex1.33 (0.45-3.98)0.606--
Haemodynamic instability2.01 (0.75-5.41)0.167--
INR8.19 (2.10-31.89)0.002--
Albumin0.924 (0.85-1.01)0.063--
Bilirubin1.02 (1.01-1.030)0.009--
Creatinine1.02 (1.01-1.035)0.024--
Sodium0.93 (0.86-0.99)0.045--
pH0.02 (0.01-0.68)0.030--
Lactate1.16 (1.02-1.31)0.019--
AIMS65 score1.96 (1.15-3.35)0.014--
GBS0.98 (0.86-1.15)0.767
Rockall score1.44 (0.86-2.43)0.168
Child-Pugh score1.40 (1.01-1.80)0.007--
MELD score1.22 (1.09-1.37)< 0.0011.21 (1.06-1.41)0.006
HCC6.58 (1.31-32.95)0.02211.51 (1.61-82.20)0.015
Re-bleeding8.76 (2.77-27.73)< 0.00113.06 (3.06- 55.71)< 0.001
SBT complications1.40 (0.44-4.51)0.573- -
TIPS performed0.30 (0.09-1.04)0.058- -
Table 5 Outcomes for patients who re-bled after Sengstaken-Blakemore tube insertion for acute severe variceal bleeding
Variable (n = 73)
No Re-bleeding (n = 48)
Re-bleeding (n = 25)
P value
Duration of mechanical ventilation (h)86.0 (46.0, 134.5)138.0 (79.0, 210.0)0.026
No. of packed RBC transfused5 (3, 7)10 (5, 16)0.001
No. of platelets transfused1 (0, 2)1 (0, 4)0.430
No. of FFP transfused2 (0, 4)6 (2, 14)0.001
6 wk mortality 13 (27.1)19 (76.0)< 0.001