Risk scoring systems to predict in-hospital mortality in patients with acute variceal bleeding due to HCV-induced liver cirrhosis

Abstract

This study was designed to validate and to compare accuracy of the prognostic scores; mainly Child Turcotte Pugh (CTP), creatinine-modified Child Turcotte Pugh (CTP-Cr), model for end-stage liver disease (MELD), albumin bilirubin score (ALBI), and AIMS65, for the predicting clinical outcomes in cirrhotic Egyptian patients presenting with acute variceal bleeding (AVB). Retrospective single center study involving 725 patients presenting with AVB due to liver cirrhosis and HCV infection either alone or mixed with HBV infection. In hospital mortality prognostic scores were calculated; mainly CTP, modified CTP-Cr, MELD, ALBI, AIMS65. The endpoint is either patient improvement or death. 725 patients were included over 1-year period. 547 (75%) survived and 178 (25%) died. Patients presented with hematemesis (515/71%), melena (120/16.5%) or hematemesis and melena (90/12.5%). Those with hematemesis for the first time were 241 (33%) and recurrent attacks were 484 (66.8%). The non-survivors had significantly more incidence of shock on presentation, more blood transfused units, history of NSAIDS intake, more ICU admission days and were more likely to be Childs C. Child, modified CTP-Cr, MELD, ALBI and ALMS65 scoring systems showed significant difference between survivors and nonsurvivors. Liver specific scores (Child, MELD) and gastrointestinal bleeding scoring systems (ALBI, AIMS65) are useful in predicting clinical outcomes of AVB in cirrhotic patients. CTP-Cr score had the highest prognostic capability of in hospital mortality. Presence of active bleeding at time of endoscopy, more complications, old age, shock and higher CPT-Cr score are additional independent predictors of in hospital mortality.

Systematic review and meta-analysis of risk scores in prediction for the clinical outcomes in patients with acute variceal bleeding

“…Eleven out of 28 studies were prospective. Nine studies reported sensitivity and specificity values [ 19 , 21 , 26 , 27 , 32 , 34 , 36 , 38 , 42 ]. All studies presented AUCs and 95% CIs.…”

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]…”

“…35,38,46,51,57,61,62 One study detailed a population including both UGIB and LGIB patients. 56 In terms of outcomes, 44 studies reported mortality, [8][9][10]18,[20][21][22][23][24][25][26][27][28][29][30][32][33][34][35][36][37]39,[41][42][43][47][48][49][52][53][54][55]58,[63][64][65][66][68][69][70][71][73][74][75] 27 rebleeding,…”

The Accuracy of Pre-Endoscopic Scores for Mortality Prediction in Patients with Upper GI Bleeding and No Endoscopy Performed

“…The main limitation of prognostic scores in variceal bleeding may be the fact that only a few of them (AIM65, ABC) are correlated to the severity of the liver failure. Some improved CPT variants including creatinine level were also proposed in order to increase accuracy [ 23 ].…”