Abstract: Objective This study aimed to investigate whether plasma fibrinogen levels affects gastroesophageal variceal rebleeding in patients with hepatitis B-induced liver cirrhosis after endoscopic treatment. Methods The patients with hepatitis B-induced liver cirrhosis and a history of gastroesophageal variceal bleeding (EVB) were encountered in Zhongshan Hospital between 2013 and 2017, and all the patients received endoscopic sandwich tissue glue injection and varicose vein ligation treatment. Based on plasma fibrinogen levels of 150 mg/dL as the cut-off-value, the patients were divided into high and low level groups. The baseline data were analyzed by ROC curve, and the Kaplan-Meier analysis was applied to compare the rebleeding rate between the two groups. The univariate and multivariate cox regression analyzes were conducted to identify the independent prognostic factors of rebleeding after endoscopic treatment. Result A total of 255 patients with liver cirrhosis and EVB history were included; the patients with low plasma fibrinogen level had significantly higher Child-Pugh score and lower platelet count (P<0.05); the Kaplan-Meier analysis showed that the patients with low fibrinogen level had a significantly higher rebleeding rate compared to those with high fibrinogen level within 1 year after endoscopic treatment (25.3% vs, 10.9%, P=0.0016), which was more pronounced in the subgroup with portal vein thrombosis compared to those without (45.2% vs, 11.3%, P=0.0002); the multivariate analysis demonstrated that the elderly patients, those with portal vein thrombosis, with diabetes mellitus or low plasma fibrinogen level (<150 mg/dL) were the independent prognostic factors for gastroesophageal variceal rebleeding. Conclusion The low plasma fibrinogen level could predict higher rebleeding risk within 1 year after endoscopic treatment in patients with EVB. The surveillance of plasma fibrinogen levels after endoscopic treatment might be guide clinical management.

Key words: Liver cirrhosis, Portal hypertension, Gastroesophageal variceal bleeding, Fibrinogen, Endoscopic treatment, re-bleeding