{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T12:14:36Z","timestamp":1774008876603,"version":"3.50.1"},"reference-count":28,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Early rebleeding after endoscopic variceal ligation (EVL) represents a serious complication in patients with cirrhosis and is associated with poor short-term outcomes. This study aimed to identify independent predictors of early rebleeding after EVL, with a particular focus on distinguishing factors associated with variceal rebleeding from those related to post-banding ulcer (PBU) bleeding, and to assess predictors of six-week mortality. Methods: We conducted a retrospective cohort study including 217 cirrhotic patients who underwent first emergency EVL for an index episode of esophageal variceal bleeding at a tertiary referral center. Early rebleeding was defined as recurrent upper gastrointestinal bleeding occurring between days 6 and 42 after the index EVL. Results: Early rebleeding occurred in 38\/217 patients (17.5%): 27\/38 (71.1%) variceal rebleeding and 11\/38 (28.9%) PBU rebleeding. In multivariable logistic regression analysis, lower hemoglobin (OR = 0.19, 95% CI: 0.067\u20130.539, p = 0.002) and a higher albumin\u2013bilirubin (ALBI) grade (OR = 24.94, 95% CI: 1.134\u2013548.342, p = 0.041) were independently associated with increased odds of early variceal rebleeding, whereas a higher number of bands applied during index EVL (OR = 0.52, 95% CI: 0.302\u20130.896, p = 0.019) was independently associated with reduced odds of rebleeding, with excellent model discrimination (area under the curve [AUC] 0.981; 95% CI: 0.959\u20131.000). For PBU rebleeding, lower fibrinogen level was the only independent predictor (OR = 0.957, 95% CI: 0.916\u20131.000, p = 0.047), with strong discriminative performance (AUC 0.945; 95% CI: 0.909\u20130.982). Model for End-Stage Liver Disease (MELD) score, serum albumin, platelet count, and PBU rebleeding independently predicted six-week mortality. Conclusions: Markers of liver function, along with endoscopic parameters, predict early rebleeding after EVL, emphasizing the importance of the complete assessment of cirrhotic patients for refined risk stratification and tailored post-EVL management.<\/jats:p>","DOI":"10.3390\/jcm15062372","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T09:44:41Z","timestamp":1773999881000},"page":"2372","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors Associated with Early Rebleeding After Endoscopic Variceal Ligation in Cirrhotic Patients: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Simona","family":"Juncu","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d University Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5621-548X","authenticated-orcid":false,"given":"Ana-Maria","family":"S\u00eengeap","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d University Hospital, 700111 Iasi, Romania"},{"name":"CENEMED Platform for Interdisciplinary Research, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7736-8140","authenticated-orcid":false,"given":"Horia","family":"Minea","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d University Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreea","family":"Lungu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d University Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandru Sebastian","family":"Cotle\u021b","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d University Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana-Maria","family":"Buzuleac","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d University Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raluca","family":"Avram","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d University Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Muzica","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d University Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Huiban","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d University Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5925-1232","authenticated-orcid":false,"given":"Irina","family":"G\u00eerleanu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d University Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alina Ecaterina","family":"Jucan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d University Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5590-6462","authenticated-orcid":false,"given":"Georgiana-Emmanuela","family":"G\u00eelc\u0103-Blanariu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d University Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0448-253X","authenticated-orcid":false,"given":"Andrei","family":"Ciobica","sequence":"additional","affiliation":[{"name":"Department of Physiology, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alin","family":"Ciobica","sequence":"additional","affiliation":[{"name":"CENEMED Platform for Interdisciplinary Research, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"},{"name":"Department of Biology, Faculty of Biology, \u201cAlexandru Ioan Cuza\u201d University of Iasi, Bd. Carol I No. 20A, 700505 Iasi, Romania"},{"name":"\u201cIoan Haulica\u201d Institute, Apollonia University, 11 P\u0103curari Street, 700511 Iasi, Romania"},{"name":"Academy of Romanian Scientists, 3 Ilfov, 050044 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9144-5520","authenticated-orcid":false,"given":"Anca","family":"Trifan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d University Hospital, 700111 Iasi, Romania"},{"name":"CENEMED Platform for Interdisciplinary Research, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6395-335X","authenticated-orcid":false,"given":"Camelia","family":"Cojocariu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d University Hospital, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Cao, C., Jin, J., Cai, R., Chu, Y., Wu, K., Wang, Z., Xiao, T., Zhang, H., Huang, H., and Liu, H. (2024). Correlation between diameter of esophageal varices and early rebleeding following endoscopic variceal ligation: A multicenter retrospective study based on artificial intelligence-based endoscopic virtual rule. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1406108"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/j.jceh.2021.08.030","article-title":"Management of Refractory Variceal Bleed in Cirrhosis","volume":"12","author":"Rodge","year":"2022","journal-title":"J. Clin. Exp. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1055\/a-1214-5355","article-title":"Risk factors associated with bleeding after prophylactic endoscopic variceal ligation in cirrhosis","volume":"53","author":"Drolz","year":"2021","journal-title":"Endoscopy"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/s43066-021-00119-2","article-title":"Predictors of early rebleeding after endoscopic therapy of first variceal bleeding in liver cirrhosis","volume":"11","author":"Alia","year":"2021","journal-title":"Egypt. Liver J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"267","DOI":"10.5114\/ceh.2022.123096","article-title":"Predictors of early bleeding after endoscopic variceal ligation for esophageal varices: A systematic review and meta-analysis","volume":"8","author":"Giri","year":"2022","journal-title":"Clin. Exp. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2569","DOI":"10.1002\/hep4.2021","article-title":"Acute hemodynamic response to propranolol predicts bleeding and nonbleeding decompensation in patients with cirrhosis","volume":"6","author":"Hofer","year":"2022","journal-title":"Hepatol. Commun."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1055\/a-1939-4887","article-title":"Endoscopic diagnosis and management of esophagogastric variceal hemorrhage. Eur Societ of Gastrointest Endoscopy (ESGE) Guideline","volume":"54","author":"Gralnek","year":"2022","journal-title":"Endoscopy"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1016\/j.jhep.2021.12.022","article-title":"Baveno VII\u2014Renewing consensus in portal hypertension","volume":"76","author":"Bosch","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1097\/HEP.0000000000000647","article-title":"AASLD Practice Guidance on risk stratification and management of portal hypertension and varices in cirrhosis","volume":"79","author":"Kaplan","year":"2024","journal-title":"Hepatology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"17562848231190970","DOI":"10.1177\/17562848231190970","article-title":"At admission hemodynamic instability is associated with increased mortality and rebleeding rate in acute gastrointestinal bleeding: A systematic review and meta-analysis","volume":"16","author":"Tari","year":"2023","journal-title":"Therap. Adv. Gastroenterol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"17941","DOI":"10.3748\/wjg.v20.i47.17941","article-title":"Risk factors for early rebleeding and mortality in acute variceal hemorrhage","volume":"20","author":"Zhao","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Ryu, H., Kim, T.U., Yoon, K.T., and Hong, Y.M. (2023). Predicting the risk of early bleeding following endoscopic variceal ligation in cirrhotic patients with computed tomography. BMC Gastroenterol., 23.","DOI":"10.1186\/s12876-023-03038-1"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.dld.2019.06.019","article-title":"Ulcer bleeding after band ligation of esophageal varices: Risk factors and prognosis","volume":"52","author":"Cachero","year":"2020","journal-title":"Dig. Liver Dis."},{"key":"ref_14","first-page":"252","article-title":"Frequency and risk factors of post banding ulcer bleeding following endoscopic variceal ligation in patients with liver cirrhosis","volume":"9","author":"Elhawari","year":"2019","journal-title":"Afro-Egypt. J. Infect. End. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"28","DOI":"10.4103\/jmisr.jmisr_50_22","article-title":"Esophageal ulcer after band ligation of esophageal varices","volume":"5","author":"Shahin","year":"2022","journal-title":"J. Med. Sci. Res."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"de Brito Nunes, M., Knecht, M., Schropp, J., Wiest, R., Bosch, J., and Berzigotti, A. (2025). Post-Banding Ulcer Bleeding After Endoscopic Ligation: Incidence, Risk Factors and Outcomes in Patients with Cirrhosis. Aliment. Pharmacol. Ther., Epub ahead of print.","DOI":"10.1111\/apt.70495"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Chen, C.W., Kuo, C.J., Lee, C.W., Kuo, T., Chiu, C.T., Lin, C.J., Lim, S.N., Yeh, C.T., and Lin, W.R. (2022). Albumin-Bilirubin Grade as a Novel Predictor of the Development and Short-Term Survival of Post-Banding Ulcer Bleeding Following Endoscopic Variceal Ligation in Cirrhotic Patients. Medicina, 58.","DOI":"10.3390\/medicina58121836"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1002\/jhbp.12057","article-title":"Predicting early rebleeding and mortality after endoscopic hemostasis of esophagogastric varices: Diagnostic performance of aspartate aminotransferase to platelet ratio index and model for end stage liver disease Na score","volume":"31","author":"Yokoyama","year":"2024","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"880","DOI":"10.4254\/wjh.v12.i10.880","article-title":"Role of platelet-albumin-bilirubin score in predicting re-bleeding after band ligation for acute variceal hemorrhage","volume":"12","author":"Faisal","year":"2020","journal-title":"World J. Hepatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"30","DOI":"10.37018\/PENC3048","article-title":"Risk factors associated with early variceal rebleed after endoscopic variceal band ligation in cirrhotic Hepatitis B and C patients with variceal bleed: Risk factors associated with early rebleed in cirrhotic patients","volume":"14","author":"Nasrullah","year":"2020","journal-title":"J. Fatima Jinnah Med. Univ."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"99","DOI":"10.55519\/JAMC-01-10722","article-title":"Predictors of re-bleeding after oesophageal variceal banding in cirrhotic patients at 4 weeks","volume":"35","author":"Asghar","year":"2023","journal-title":"J. Ayub Med. Coll. Abbottabad."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"101","DOI":"10.5009\/gnl20375","article-title":"Minimal and maximal extent of band ligation for acute variceal bleeding during the first endoscopic session","volume":"16","author":"Jung","year":"2021","journal-title":"Gut Liver"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3347","DOI":"10.3748\/wjg.v17.i28.3347","article-title":"Risk factors for predicting early variceal rebleeding after endoscopic variceal ligation","volume":"17","author":"Xu","year":"2011","journal-title":"World J. Gastroenterol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1852","DOI":"10.1007\/s10620-024-08382-0","article-title":"A Novel Nomogram for Predicting Early Rebleeding After Endoscopic Treatment of Esophagogastric Variceal Hemorrhage","volume":"69","author":"Dong","year":"2024","journal-title":"Dig. Dis. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"830","DOI":"10.5604\/01.3001.0012.0775","article-title":"Low fibrinogen levels are associated with bleeding after varices ligation in thrombocytopenic cirrhotic patients","volume":"17","author":"Giannini","year":"2018","journal-title":"Ann. Hepatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1007\/s12072-025-10894-4","article-title":"Management of acute variceal bleeding: Updated APASL guidelines","volume":"19","author":"Lesmana","year":"2025","journal-title":"Hepatol. Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.51253\/pafmj.v73i6.8835","article-title":"Post Banding Ulcer Haemorrhage: A Contributor to Morality in Patients with Liver Cirrhosis","volume":"73","author":"Parveen","year":"2023","journal-title":"Pak. Armed Forces Med. J."},{"key":"ref_28","first-page":"5488","article-title":"Prediction of Recurrent Variceal Bleeding in Cirrhotic Patients after Endoscopic Variceal Ligation","volume":"31","author":"Ahmed","year":"2025","journal-title":"Zagazig Univ. Med. J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2372\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T10:10:47Z","timestamp":1774001447000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2372"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,20]]},"references-count":28,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15062372"],"URL":"https:\/\/doi.org\/10.3390\/jcm15062372","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,20]]}}}