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

Yang, Ling; Sun, Rui; Wei, Ning; Cui, Hong

doi:10.1080/07853890.2021.1990394

Cited by 11 publications

(6 citation statements)

References 46 publications

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“…Other reports comparing several different scores used in patients with liver cirrhosis (MELD-model for end-stage liver disease, APACHE II-acute physiology and chronic health evaluation II, qSOFA-quick sepsis related organ failure assessment) confirmed higher accuracy of AIMS65 in predicting in-hospital mortality[ 1 ]. Similar predictive power for in-hospital mortality of AIMS65 score, Child-Pugh score (CTP) and MELD score was found in a metanalysis performed on a variceal bleeding population[ 20 ].…”

Section: Discussionmentioning

confidence: 65%

Age, blood tests and comorbidities and AIMS65 risk scores outperform Glasgow-Blatchford and pre-endoscopic Rockall score in patients with upper gastrointestinal bleeding

Morarasu¹,

Șorodoc²,

Haisan³

et al. 2023

World J Clin Cases

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BACKGROUND Upper gastrointestinal (GI) bleeding is a life-threatening condition with high mortality rates. AIM To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes: In-hospital mortality, intervention (endoscopic or surgical) and length of admission (≥ 7 d). METHODS We performed a retrospective analysis of 363 patients presenting with upper GI bleeding from December 2020 to January 2021. We calculated and compared the area under the receiver operating characteristics curves (AUROCs) of Glasgow-Blatchford score (GBS), pre-endoscopic Rockall score (PERS), albumin, international normalized ratio, altered mental status, systolic blood pressure, age older than 65 (AIMS65) and age, blood tests and comorbidities (ABC), including their optimal cut-off in variceal and non-variceal upper GI bleeding cohorts. We subsequently analyzed through a logistic binary regression model, if addition of lactate increased the score performance. RESULTS All scores had discriminative ability in predicting in-hospital mortality irrespective of study group. AIMS65 score had the best performance in the variceal bleeding group (AUROC = 0.772; P < 0.001), and ABC score (AUROC = 0.775; P < 0.001) in the non-variceal bleeding group. However, ABC score, at a cut-off value of 5.5, was the best predictor (AUROC = 0.770, P = 0.001) of in-hospital mortality in both populations. PERS score was a good predictor for endoscopic treatment (AUC = 0.604; P = 0.046) in the variceal population, while GBS score, (AUROC = 0.722; P = 0.024), outperformed the other scores in predicting surgical intervention. Addition of lactate to AIMS65 score, increases by 5-fold the probability of in-hospital mortality ( P < 0.05) and by 12-fold if added to GBS score ( P < 0.003). No score proved to be a good predictor for length of admission. CONCLUSION ABC score is the most accurate in predicting in-hospital mortality in both mixed and non-variceal bleeding population. PERS and GBS should be used to determine need for endoscopic and surgical intervention, respectively. Lactate can be used as an additional tool to risk scores for predicting in-hospital mortality.

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Section: Discussionmentioning

confidence: 65%

Age, blood tests and comorbidities and AIMS65 risk scores outperform Glasgow-Blatchford and pre-endoscopic Rockall score in patients with upper gastrointestinal bleeding

Morarasu¹,

Șorodoc²,

Haisan³

et al. 2023

World J Clin Cases

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“…Although esophagogastroduodenoscopy (EGD) is an irreplaceable device for risk assessment and prophylactic treatment of VH, patients highly inclined to occurring or recurring VH may not be able to receive endoscopic treatment in time as restricted by its invasive nature and limited availability. Recently, combined models containing non‐invasive clinical variables have been established to evaluate the disease severity and prognosis of cirrhotic patients 7,8 . Some models, such as the Child–Turcotte–Pugh (CTP) classification and model for end‐stage liver disease (MELD) score, have been applied for clinical decision‐making and found to have good predictive value, which offers the possibility of non‐invasive prognostic prediction of PVT in patients with cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, combined models containing non-invasive clinical variables have been established to evaluate the disease severity and prognosis of cirrhotic patients. 7,8 Some models, such as the Child-Turcotte-Pugh (CTP) classification and model for end-stage liver disease (MELD) score, have been applied for clinical decision-making and found to have good predictive value, which offers the possibility of non-invasive prognostic prediction of PVT in patients with cirrhosis.…”

mentioning

confidence: 99%

Predicting the risk of variceal rehemorrhage in cirrhotic patients with portal vein thrombosis: A two‐center retrospective study

Zhang,

Zhong,

Zhong

et al. 2023

J of Digest Diseases

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Background and aimsAlthough portal vein thrombosis (PVT) was considered worsening portal hypertension and leading to poor prognosis, the risk stratification still be unclear. This study was to evaluate its effect on the risk of variceal rehemorrhage, accordingly identify the clinical predictors and develop a competitive risk model utilized for cirrhotic patients with PVT.MethodsCirrhotic patients with and without PVT admitted for variceal hemorrhage were retrospectively included by matching (1:1) for sex, age and etiology from two tertiary centres for 1‐year follow‐up, of which patients with PVT were divided into the training and validation cohort. Cox regression analysis was performed to identify risk factors and therefore develop a competitive risk model, of which the predictive performance and the optimal decision threshold were evaluated by C‐index, competitive risk curves, calibration curves and decision curve analysis.ResultsWe included 398 patients and firstly found that PVT could significantly increase variceal rehemorrhage risk. Then, multivariate Cox regression analysis identified that CTP score (P = 0.013), time course of PVT (P = 0.025), CRP (P < 0.001) and AST (P = 0.039) were independently associated with variceal rehemorrhage, which were incorporated into the competitive risk model, with high C‐index (0.804 and 0.742 of the training and validation cohort, respectively), risk stratification ability and consistency. The optimal decision range of the threshold probability was 0.2–1.0.ConclusionsThis study not only confirmed the harmful effect of PVT on variceal rehemorrhage but also developed a competitive risk model for cirrhotic patients with PVT, which could be conveniently used for clinical decision making.This article is protected by copyright. All rights reserved.

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“…Although esophagogastroduodenoscopy (EGD) is an irreplaceable measure for risk assessment and prophylactic treatment of VH, restricted by its invasive nature and its limited availability, patients highly inclined occuring or recurring VH may not be able to receive endoscopic treatment in time. In recent decades, combined models containing non-invasive clinical variables had been developed to evaluate the severity and prognosis of cirrhotic patients [7,8], some of which, including Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease (MELD) score, had been applied for clinical decision-making with well predictive value, which offers possibility for non-invasive prognostic prediction of PVT in cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

Predict the Risk of Variceal Rehemorrhage in Cirrhotic Patients with Portal Vein Thrombosis: A Two-Center Retrospective Study

Zhang

Hui

Zhong

et al. 2023

Preprint

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Background and aims Although portal vein thrombosis (PVT) was confirmed worsening portal hypertension and leading to poor prognosis, the risk stratification of such patients still be unclear. This study was to identify the clinical predictors of variceal rehemorrhage (VRH) and accordingly develop a competitive risk model in cirrhotic patients with PVT. Methods Cirrhotic patients with PVT admitted for variceal hemorrhage were retrospectively included from two tertiary centres and respectively served as the training and validation cohort for 1-year follow-up. A competitive risk model was developed based on the result of multivariate Cox regression analysis, of which the predictive performance and the optimal decision threshold were evaluated by C-index, competitive risk curves, calibration curves and decision curve analysis. Results A total of 199 patients completed 1-year follow-up, of which 64 (31.8%) patients occurred VRH. Multivariate Cox regression identified that CTP score (P=0.020), time course of PVT (P=0.036), CRP (P<0.001) and AST (P=0.047) were independently associated with VRH, which were incorporated into the competitive risk model, with high C-index (0.804 and 0.742 of the training and validation cohort, respectively). Competitive risk curves and calibration curves demonstrated its high risk stratification ability and consistency. The optimal decision range of the threshold probability was 0.2-1.0. Conclusions This study found that CTP score, time course of PVT, CRP and AST were independent predictors of VRH, based on which the competitive risk model could be conveniently used for clinical decision making in cirrhotic patients with PVT.

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

Cited by 11 publications

References 46 publications

Age, blood tests and comorbidities and AIMS65 risk scores outperform Glasgow-Blatchford and pre-endoscopic Rockall score in patients with upper gastrointestinal bleeding

Age, blood tests and comorbidities and AIMS65 risk scores outperform Glasgow-Blatchford and pre-endoscopic Rockall score in patients with upper gastrointestinal bleeding

Predicting the risk of variceal rehemorrhage in cirrhotic patients with portal vein thrombosis: A two‐center retrospective study

Predict the Risk of Variceal Rehemorrhage in Cirrhotic Patients with Portal Vein Thrombosis: A Two-Center Retrospective Study

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