Predicting 6-week mortality after acute variceal bleeding: role of classification and regression tree analysis

Altamirano, José; Zapata, Laura; Augustín, Salvador; Muntaner, Laura; González-Angulo, A; Ortiz, Ana Laura; Degiau, Louis; Garibay, Juan Manuel; Camargo, Leonardo Figueiredo; Genescà, Joan

doi:10.1016/s1665-2681(19)31743-0

Cited by 20 publications

(14 citation statements)

References 22 publications

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“…Krige et al[12] found in a study done exclusively in alcoholic cirrhosis, that CTP class C, encephalopathy, ascites, bilirubin > 51 mmol/L, INR > 2.3, albumin < 25 g/L and patients who require balloon tamponade were factors related to 6-wk mortality. In this study we also found that the CTP class C was significantly related to 6-wk mortality ( P value < 0.02) this was similar to findings in other studies[3,12,13]. Furthermore factors related to mortality within the first 5 d following AVH in cirrhosis were again the CTP class C and the rebleeding within these 5 d. Bambha et al[11] suggested that the MELD score rather than CTP class was more powerful in predicting 6-wk mortality.…”

Section: Discussionsupporting

confidence: 92%

“…In this study, the rebleeding rate among cirrhosis group was high at 56% and 25% of these patients developed rebleeding within the first 5 d. The 6-wk rebleeding rate reported in literature was 16.2%, 30% and 24.2%[2,12,13]. …”

Section: Discussionmentioning

confidence: 67%

“…This study is unique because we evaluated the patients in two groups according to the etiology of the underlying liver disease, either liver cirrhosis or schistosomal periportal fibrosis. Previous studies on early mortality following AVH were done exclusively on patients with liver cirrhosis[3,11-13]. …”

Section: Discussionmentioning

confidence: 99%

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Mortality and rebleeding following variceal haemorrhage in liver cirrhosis and periportal fibrosis

Mohammed

Abdo

Mudawi

2016

WJH

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AIMTo investigate mortality and rebleeding rate and identify associated risk factors at 6 wk and 5 d following acute variceal haemorrhage in patients with liver cirrhosis and schistosomal periportal fibrosis.METHODSThis is a prospective study conducted during the period from March to December 2014. Patients with portal hypertension presenting with acute variceal haemorrhage secondary to either liver cirrhosis (group A) or schistosomal periportal fibroses (group B) presenting within 24 h of the onset of the bleeding were enrolled in the study and followed for a period of 6 wk. Analysis of data was done by Microsoft Excel and comparison between groups was done by Statistical Package of Social Sciences version 20 to calculate means and find the levels of statistical differences and define the mortality rates, the P value of < 0.05 was considered to be significant.RESULTSA total of 94 patients were enrolled in the study. Thirty-two patients (34%) had liver cirrhosis (group A) and 62 (66%) patients had periportal fibrosis (group B). Mortality: The 6-wk and 5-d mortality were 53% and 16% respectively in group A compared to 10% and 0% in group B (P value < 0.000 and < 0.004). In group A; a Child-Turcotte-Pugh class C and rebleeding within 5 d were significantly associated with 5-d mortality (P value < 0.029 and < 0.049 respectively) and Child- Turcotte-Pugh class C was also a significant risk factor for 6-wk mortality (P value < 0.018). In group B; mortality was significantly associated with rebleeding within the 6-wk follow-up period and requirement for blood transfusion on admission (P value < 0.005 and < 0.049). Rebleeding: The 6-wk and 5-d rebleeding rate in group A were 56% and 25% respectively compared to 32% and 3% in group B (P value < 0.015 and < 0.002). Clinical presentation with encephalopathy was a significant risk factor for 5 d rebleeding in group A (P value < 0.005) while grade III periportal fibrosis and requirement for blood transfusion on admission were significant risk factors for 6-wk rebleeding in group B (P value < 0.004 and < 0.02).CONCLUSIONThe 6-wk and 5-d mortality and rebleeding rate were significantly higher in patients with liver cirrhosis compared to patients with schistosomal periportal fibrosis.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 67%

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Mortality and rebleeding following variceal haemorrhage in liver cirrhosis and periportal fibrosis

Mohammed

Abdo

Mudawi

2016

WJH

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“…The Altamirano et al [18] study on 60 consecutive cirrhotic patients with acute variceal bleeding revealed that the early rebleeding rate was 13%, and variables associated with early rebleeding were serum albumin, creatinine and the number of transfused blood units in the first 24 h. In our study, serum albumin was not significantly different between rebleeders and nonrebleeders.…”

Section: Discussioncontrasting

confidence: 45%

The MELD score for the prediction of early variceal rebleeding after endoscopic intervention

Elbokl¹,

Kaisar²,

Ali-Eldin³

et al. 2014

Egyptian Liver Journal

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BackgroundCombined treatment with vasoactive drugs, prophylactic antibiotics and endoscopic techniques is the recommended standard of care for patients with acute variceal bleeding. However, treatment failure occurs in about 10-15% of patients. With the development and validation of the Model for End-stage Liver Disease (MELD) scoring system as an index of the severity of liver disease, it is now possible to use it as predictor of survival and variceal rebleeding. ObjectivesThe aim of this study was to investigate the value of the MELD score in predicting early variceal rebleeding after endoscopic intervention in cirrhotic patients. Materials and methodsThis study included 100 randomly selected patients admitted with acute variceal hemorrhage. All patients were subjected to mult-operator endoscopic intervention (band ligation or sclerotherapy) to control bleeding. Patients were followed for 1 week to detect variceal rebleeding. The MELD score and the Child Pugh score were calculated for all patients. ResultsRebleeding occurred in 22% of the patients and the mean time for rebleeding was 2.591 ± 1.552 days. Patients with rebleeding had a younger age, used the Sengestaken tube more frequently, required packed RBCs transfusion and had a larger size of varices, higher serum creatinine, higher INR, higher serum total bilirubin and a higher MELD score than nonrebleeders. Patients with rebleeding also had a higher Child class and their varices were mainly esophageal. At a cutoff value of more than 20, the MELD score had a sensitivity of 90.91%, a specificity of 75.64%, a positive predictive value of 51.3% and a negative predictive value of 96.7% in predicting early rebleeding with the area under the ROC curve being 0.892. ConclusionAddition of the MELD score as a predictor of early variceal rebleeding will improve the ability to identify patients who are at a substantially increased risk of rebleeding over a short term. Patients with MELD more than 20 have a high risk of rebleeding.

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“…Multiple studies [19][20][21][22][23][24][25][26] have compared the performance of CP versus MELD (along with other novel models) in estimating mortality following AVB (►Table 2). While model performance in terms of discrimination is frequently assessed, model calibration has been rarely performed.…”

Section: Child-pugh As a Prognostic And Decision Tool In Acute Varicementioning

confidence: 99%

Child–Pugh Classification: Time to Abandon?

Kok

Abraldes

2019

Semin Liver Dis

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The Child–Pugh classification is one of the commonest and oldest bedside tools utilized in estimating prognosis in patients with cirrhosis. However, its usage as a risk prediction tool or indeed a decision-making tool should be revisited. In this review, we discuss some inherent issues with the Child–Pugh classification and present a few contexts in which the current usage of Child–Pugh warrants reassessment, elaborating on its utility in acute variceal bleeding, specifically its role in decision-making on early transjugular intrahepatic portosystemic shunt, as well as its use in the context of hepatocellular carcinoma and drug development and dose adjustment.

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Predicting 6-week mortality after acute variceal bleeding: role of classification and regression tree analysis

Cited by 20 publications

References 22 publications

Mortality and rebleeding following variceal haemorrhage in liver cirrhosis and periportal fibrosis

Mortality and rebleeding following variceal haemorrhage in liver cirrhosis and periportal fibrosis

The MELD score for the prediction of early variceal rebleeding after endoscopic intervention

Child–Pugh Classification: Time to Abandon?

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