A Novel risk score to predict first attack of esophageal variceal bleeding in cirrhotic patients

Abstract

Background: Variceal bleeding (VB) is lethal complication of liver cirrhosis requisite rapid identification to apply prevention strategies. The objective of this study is to identify predictors of the first VB attack and establish a score to estimate the probability of this attack. Methods. The study comprised 236 cirrhotic individuals who had been admitted with first attack of upper gastrointestinal bleeding (UGIB). Based on index hospitalisation data, a multivariable logistic regression model was utilized to determine predictors of the first VB attack. The Mousa score was created as a consequence to predict first VB attack. Results. Out of the 236 patients hospitalized with UGIB, 154 had esophageal varices as the culprit bleeding lesion, whereas the remaining 82 had different culprit bleeding lesions. Age 60 years, presence of diabetes mellitus, lack of ischemic heart disease, platelets 130 (103/dL), albumin >2.9 g/dl, bilirubin >1.4 mg/dl, and Child score B were shown to be predictors of first VB attack. Using these predictors, the Mousa score was calculated to forecast first VB attack. ROC analysis demonstrated that at a cut-off ≥4, Mousa score had discriminative power for predicting VH with sensitivity 77.3 and specificity 75.6%. Quartiles classification of score revealed that, when the score was < 3 points (low risk) the sensitivity was 95.5% and specificity was 40.2%, however, when score was ≥ 5 points (high risk) the sensitivity was 93.9 % and specificity was 50.7 %. Conclusions: Mousa score can be useful and easily applied for prediction of first VB attack in cirrhotic patients which can help with proper treatments.