Bedside risk‐scoring model for predicting 6‐week mortality in cirrhotic patients undergoing endoscopic band ligation for acute variceal bleeding

Abstract

Background and Aim: Acute variceal bleeding (AVB) is a fatal adverse event of cirrhosis, and endoscopic band ligation (EBL) is the standard treatment for AVB. We developed a novel bedside risk-scoring model to predict the 6-week mortality in cirrhotic patients undergoing EBL for AVB. Methods: Cox regression analysis was used to assess the relationship of clinical, biological, and endoscopic variables with the 6-week mortality risk after EBL in a derivation cohort (n = 1373). The primary outcome was the predictive accuracy of the new model for the 6-week mortality in the validation cohort. Moreover, we tested the adequacy of the mortality risk-based stratification and the discriminative performance of our new model in comparison with the Child-Turcotte-Pugh (CTP) and the model for end-stage liver disease scores in the validation cohort (n = 200). Results: On multivariate Cox regression analysis, five objective variables (use of betablockers, hepatocellular carcinoma, CTP class C, hypovolemic shock at initial presentation, and history of hepatic encephalopathy) were scored to generate a 12-point risk-prediction model. The model stratified the 6-week mortality risk in patients as low (3.5%), intermediate (21.1%), and high (53.4%) (P < 0.001). Time-dependent area under the receiver operating characteristic curve for 6-week mortality showed that this model was a better prognostic indicator than the CTP class alone in the derivation (P < 0.001) and validation (P < 0.001) cohorts. Conclusions: A simplified scoring model with high potential for generalization refines the prediction of 6-week mortality in high-risk cirrhotic patients, thereby aiding the targeting and individualization of treatment strategies for decreasing the mortality rate.

At admission hemodynamic instability is associated with increased mortality and rebleeding rate in acute gastrointestinal bleeding: a systematic review and meta-analysis

“…In terms of outcomes, 44 studies reported mortality, 8–10,18,20–30,32–37,39,41–43,47–49,52–55,58,63–66,68–71,73–75 27 rebleeding, 8,19,20,22,25,29–31,34,35,38–40,43,45,46,50,51,55–57,60,68,70,72,…”

“…The rate of HI/shock ranged between 1.2% and 68.3% of the eligible studies. The source of bleeding was UGIB in 54 of the included studies, [8][9][10][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]36,37,[39][40][41][42][43][44][45][47][48][49][50][52][53][54][55][58][59][60][63][64][65][66][67][68][69][70][71][72][73][74]…”

Novel nomogram model for predicting 6‐week mortality in liver cirrhosis patients with acute upper gastrointestinal bleeding

“…Through literature review of previous studies, we found three clinical predictive models that are similar to the UGIB‐LC score, including CAGIB score, MELDNa‐AGIB model, and the Bedside risk‐scoring model 33–35 . The variables of the CAGIB score include diabetes mellitus (DM), hepatocellular carcinoma (HCC), TBIL, ALB, ALT, and SCr.…”

“…Child-Pugh score, MELD score, and NLR as control methods to evaluate the UGIB-LC score in predicting the 6-week mortality of liver cirrhosis patients with acute UGIB, and revealed that the UGIB-LC score was superior to these scoring systems in predicting the 6-week mortality risk in such patients. Through literature review of previous studies, we found three clinical predictive models that are similar to the UGIB-LC score, including CAGIB score, MELDNa-AGIB model, and the Bedside risk-scoring model [33][34][35]. The variables of the CAGIB score include diabetes mellitus (DM), hepatocellular carcinoma (HCC), TBIL, ALB, ALT, and SCr.Zhao et al suggested that the CAGIB score was superior to Child-Pugh and MELD scores in predicting mortality in a F I G U R E 5 Calibration curve plot in the A, internal validation and B, external validation sets, showing good agreement between prediction and observation F I G U R E 6 The receiver operating characteristic (ROC) curve of upper gastrointestinal bleeding-liver cirrhosis (UGIB-LC) score, Child-Pugh score, model for end-stage liver disease (MELD) score, and neutrophil-to-lymphocyte ratio (NLR) in A, the training cohort and B, the validation cohort cohort of patients with HCC.…”

The complexities of predicting outcome in cirrhotic patients with acute variceal bleeding

“…We read with interest the paper "Bedside risk-scoring model for predicting 6-week mortality in cirrhotic patients undergoing endoscopic band ligation for acute variceal bleeding" published in the May issue of Journal of Gastroenterology and Hepatology. 1 The authors used Cox regression analysis to assess the relationship between clinical, biological, and endoscopic variables and 6-week mortality risk after EBL in a derivation cohort (n = 1373). The primary outcome was the predictive accuracy of the new model for the 6-week mortality in the validation cohort.…”