The Prognosis Analysis of Liver Cirrhosis with Acute Variceal Bleeding and Validation of Current Prognostic Models: A Large Scale Retrospective Cohort Study

Abstract

Background. Acute variceal bleeding is a major cause of death in liver cirrhosis. This large scale retrospective cohort study aims to analyze the prognosis of patients with cirrhosis and acute variceal bleeding and to validate the current prognostic models. Methods. Patients with cirrhosis and acute variceal bleeding were enrolled from Jan 2019 to March 2020. The independent prognostic factors for in-hospital death were identified by logistic regression analyses. Area under curves (AUCs) was compared among Child-Pugh, cirrhosis acute gastrointestinal bleeding (CAGIB) score, and model for end-stage liver disease (MELD) and neutrophil-lymphocyte ratio (NLR) scores. Results. Overall, 379 patients with liver cirrhosis and acute variceal bleeding were consecutively evaluated. The majority of the patients were males (59.1%) and the mean age of all patients were 53.7±1.3 years (range 14-89). Hepatitis B virus (HBV) was the most common underlying cause of liver cirrhosis (54.1%). 72 (19%) patients had hepatocellular carcinoma. Multivariate logistic regression analyses showed that age, HCC, WBC, total serum bilirubin, serum creatinine, and ALT were independently associated with in-hospital death. And the odds ratios (ORs) for in-hospital death were 1.066 (95% CI 1.017-1.118, P=0.008), 7.19 (95% CI 2.077-24.893, P=0.001), 1.123 (95% CI 1.051-1.201, P=0.001), 1.014 (95% CI 1.005-1.023, P=0.003), 1.012 (95% CI 1.004-1.021, P=0.006), and 1.005 (95% CI 1.000-1.009, P=0.036), respectively. In the whole cohort with HCC patients, the AUCs of Child-Pugh, CAGIB, MELD and NLR scores were 0.842 (95% CI 0.801-0.878), 0.840 (95% CI 0.799-0.876), 0.798 (95% CI 0.754-0.838), and 0.688 (95% CI 0.639-0.735), respectively. The differences were statistically significant between Child-Pugh and NLR scores (P=0.0118), and between CAGIB and NLR scores (P=0.0354). Conclusion. Child-Pugh and CAGIB scores showed better predictive performance for prognosis of patients with cirrhosis and acute variceal bleeding than NLR scores.

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

“…And one study was excluded because the UGIB was not confirmed by an endoscope. At last, 28 articles were included in the study [ 13 , 14 , 19–44 ] (see Figure 1 ).…”

“…It is commonly used to estimate mortality in patients who had a transjugular intrahepatic portosystemic shunt (TIPS) procedure [ 11 ] and prioritize for receipt of a liver transplant [ 12 ]. Previous studies had reported the two staging systems’ predictive abilities in AVB patients’ outcomes, but which could reflect the prognosis more accurately remained controversial [ 13 , 14 ]. We aim to conduct a systematic review of the predictive value of GBS, AIMS65, Rockall (clinical Rockall score and full Rockall score), CTP and MELD in risking stratify AVB patients for mortality and rebleeding within three months after the initial bleeding.…”

Portal vein thrombosis associated with high 14-day and 6-week rebleeding in patients after oesophageal variceal band ligation: a retrospective, multicentre, nested case–control study

“…In our study, the rates of rebleeding and mortality at 6 weeks were lower than those reported in previous studies [4,17]. This nding could be attributed to the following reasons: rst, new medications and techniques have been developed recently to effectively decrease PH and prevent rebleeding; second and more importantly, it was the rst EVL for our patients; more than half of our patients had never had a bleeding before and 90% of the patients were having a Child-Pugh class A or B; third, patients with hepatocellular carcinoma, which has been reported to be associated with the prognosis of patients who have experienced an episode of variceal bleeding[26, [43][44][45]were excluded from our study. Rebleeding occurred in 21.10% and 20.18% of patients with PVT and CCG, respectively, at 1 year.…”

A New Scoring System for Predicting In-hospital Death in Patients Having Liver Cirrhosis With Esophageal Varices

“…The MELD-Na and CAGIB scores were calculated using relevant data in the following formula: MELD-Na = 3.8 × log e (bilirubin [mg/dl]) + 11.2 × log e (INR) + 9.6 × log e (creatinine [mg/dl]) + 6.4 × (etiology: 0 for cholestasis or alcohol, otherwise 1) + 1.59 × [135 – sodium (mmol/L)], and CAGIB score = DB(1 for yes, 0 for no) × 1.040 + HCC(1 for yes, 0 for no) × 0.974 + bilirubin (μmoI/L) × 0.005 – albumin (g/L) × 0.091 + ALT (U/L) × 0.001 + creatinine (μmoI/L) × 0.012 – 3.964 ( 21 ).…”