Predicting Early Mortality After Acute Variceal Hemorrhage Based on Classification and Regression Tree Analysis

Augustín, Salvador; Muntaner, Laura; Altamirano, José; González, Antonio; Saperas, Esteban; Dot, Joan; Abu-Suboh, Monder; Armengol, J R; Malagelada, Joan Ramón; Esteban, Rafael; Guàrdia, J; Genescà, Joan

doi:10.1016/j.cgh.2009.08.011

Cited by 143 publications

(110 citation statements)

References 29 publications

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“…Early rebleeding and mortality rate increase sharply within 6 weeks period then stabilized. Early rebleeding rate in the current study was 25.5%, a similar result reported by Krige et al [12] but it is slightly higher than that in some other studies [3] [13] while it is lower than that in other studies [14] [15].…”

Section: Discussionsupporting

confidence: 40%

Prediction of Early Rebleeding and Mortality after Acute Esophageal Variceal Hemorrhage among Yemeni Patients in Major Hospitals—Sana’a

Hunaysh¹

2016

OJGas

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Background and aims: Acute variceal hemorrhage (AVH) is the most serious encountered complication of liver cirrhosis and carries high mortality rate. Several risk factors that predict early rebleeding and mortality have been studied and there is no similar study in our country, so the aim of this study was to identify the risk factors of early rebleeding and mortality after bleeding episode in cirrhotic patients in Yemen. Patients and Method: It was a prospective study of cirrhotic patients with AVH who were admitted to the main public hospitals in Sana'a between April 2014 and March 2015. Demographic information, medical histories, physical examination findings, and laboratory test results were collected. Endoscopic and pharmacologic treatment was performed. The patients were followed up since admission and up to 6 weeks for the occurrence of rebleeding and mortality after the acute attack. Univariate and multivariate analyses were performed to identify independent risk factors for rebleeding and mortality. Survival analysis was estimated using the Kaplan-Meier method. Result: A total of 102 patients were analyzed. 26 patients (25.5%) rebleeded within 6 weeks period. The predictive factors significantly associated with rebleeding within 6 weeks period in univariate analysis were clot on varix at index endo-scope (P < 0.0001), high serum bilirubin (P = 0.02), CTP score (P < 0.05) and MELD score (P < 0.05). Independent risks factors remained in multivariate analysis as significant predictors of early rebleeding were clot on varix (OR: 11.6, CI: 2.87 -47.29, P = 0.001) and high serum bilirubin (>3) (OR: 1.1, CI: 1.02 -1.19, P = 0.01). Sixteen patients died (15.7%) within 6 weeks period. Predictors of mortality with significant difference in univariate analysis were hypovolemic shock (P = 0.001), high WBCs count (P < 0.0001), low serum sodium (P = 0.04), high AST (P < 0.0001), high ALT (P = 0.02), high INR (P < 0.0001), high serum bilirubin (P < 0.0001), low serum albumin (P = 0.005), ascites (P = 0.001), A. Y. Hunaysh 215 CTP score (P < 0.0001) and MELD score (P < 0.0001). By multiple regression analysis high MELD score (≥19) (OR: 1.3, CI: 1.12 -1.41, P < 0.0001) and WBCs over 10.3 × 10 9 /l (OR: 1.2, CI: 1.02 -1.40, P < 0.05) were independent risk factors for mortality within 6 weeks period. Conclusion: Early rebleeding in cirrhotic patients with AVH was associated with clot on varix at endoscope and high serum bilirubin more than 3 mg/dl. Early mortality rate was associated with high MELD score (≥19) and WBCs over 10.3 × 10 9 /l.

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Section: Discussionsupporting

confidence: 40%

Prediction of Early Rebleeding and Mortality after Acute Esophageal Variceal Hemorrhage among Yemeni Patients in Major Hospitals—Sana’a

Hunaysh¹

2016

OJGas

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“…1,2,4 The risk of death after acute variceal bleeding shows an evolution similar to that of rebleeding, peaking during the first 24 hours, and declining after 5 days and returning to the baseline after 6 weeks. 16 Our observations and those of others show that the efficacy of endoscopic intervention in controlling acute oesophageal variceal bleeding and mortality from bleeding are closely related to the severity of the underlying liver disease. 3,5,8 As anticipated, mortality in our study increased exponentially as liver reserve diminished.…”

Section: Discussionmentioning

confidence: 79%

Outcome in decompensated alcoholic cirrhotic patients with acute variceal bleeding

et al. 2012

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“…There are many different classification tools, including neural networks, Bayesian networks, and support vector machines, but models based on these may be more difficult to interpret or apply in clinical practice. On the other hand, decision tree approaches such as C4.5 and CART are widely used in biomedical studies [37][38][39] and provide a simple and intuitive hierarchical format that in many cases can be used without a computer.…”

Section: Discussionmentioning

confidence: 99%

Factors predictive of sustained virological response following 72 weeks of combination therapy for genotype 1b hepatitis C

et al. 2011

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Predicting Early Mortality After Acute Variceal Hemorrhage Based on Classification and Regression Tree Analysis

Cited by 143 publications

References 29 publications

Prediction of Early Rebleeding and Mortality after Acute Esophageal Variceal Hemorrhage among Yemeni Patients in Major Hospitals—Sana’a

Prediction of Early Rebleeding and Mortality after Acute Esophageal Variceal Hemorrhage among Yemeni Patients in Major Hospitals—Sana’a

Outcome in decompensated alcoholic cirrhotic patients with acute variceal bleeding

Factors predictive of sustained virological response following 72 weeks of combination therapy for genotype 1b hepatitis C

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