Abstract
BackgroundEsophageal variceal hemorrhage (EVH) is one of the high mortality complications in cirrhotic patients. Endoscopic variceal ligation (EVL) is currently the standard therapy for EVH. However, some patients have expired during hospitalization or survived shortly after management.AimTo evaluate hospital and 6-week mortality by receiver operating characteristic (ROC) curve of chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score compared to a model for end-stage liver disease (MELD) score and Child–Turcotte–Pugh (CTP) class.MethodsWe retrospectively collected 714 cirrhotic patients with EVH post EVL between July 2010 and June 2016 at Taitung MacKay Memorial Hospital, Taiwan. CLIF-SOFA score, MELD score, and CTP class were calculated for all patients admitted.ResultsAmong the 714 patients, the overall hospital and 6-week mortality rates were 6.9% (49/715) and 13.1% (94/715) respectively. For predicting hospital death, area under receiver operating characteristic curve (AUROC) values of CLIF-SOFA score, MELD score, and CTP class were 0.964, 0.876, and 0.846. For predicting 6-week death, AUROC values of CLIF-SOFA score, MELD score, and CTP class were 0.943, 0.817, and 0.834. CLIF-SOFA score had higher AUROC value with statistical significance under pairwise comparison than did MELD score and CTP class in prediction of not only hospital but also 6-week mortality. The history of hepatocellular carcinoma was the risk factor for 6-week mortality. For patients with hepatocellular carcinoma the cut-point of CLIF-SOFA score was 5.5 for 6-week mortality and 6.5 for hospital mortality on admission. For patients without hepatocellular carcinoma, the cut-point of CLIF-SOFA score was 6.5 for both 6-week and hospital mortality.ConclusionCLIF-SOFA score predicted post-EVL prognosis well. For patients without hepatocellular carcinoma, CLIF-SOFA score ≥6 suggests higher 6-week mortality and CLIF-SOFA score ≥7 suggests higher hospital mortality. For patients with hepatocellular carcinoma, CLIF-SOFA score ≥7 suggests higher 6-week and hospital mortality.
Highlights
Acute esophageal variceal hemorrhage (EVH) is one of the lethal complications in patients with liver cirrhosis
There were 146 (21%) patients who had a history of hepatocellular carcinoma
Except for history of hepatocellular carcinoma, there were no significant differences in age, gender, and cause of liver cirrhosis between survivors and nonsurvivors
Summary
Acute esophageal variceal hemorrhage (EVH) is one of the lethal complications in patients with liver cirrhosis. Endoscopic variceal ligation (EVL) is currently the standard therapy for acute EVH[1]. Patient survival has improved under advanced endoscopy, antibiotic prophylaxis, and vasoactive medication, the mortality rate is still up to 20% for each episode of acute variceal hemorrhage[2,3,4,5]. According to the Baveno VI consensus, 6-week mortality was suggested for primary endpoint of acute variceal hemorrhage. Child–Turcotte–Pugh (CTP) class, end-stage liver disease (MELD) score, and primary hemostasis were useful for predicting 6-week mortality[6]. Esophageal variceal hemorrhage (EVH) is one of the high mortality complications in cirrhotic patients. Endoscopic variceal ligation (EVL) is currently the standard therapy for EVH. Some patients have expired during hospitalization or survived shortly after management
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