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

Abstract

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.