Development and Validation of CAGIB Score for Evaluating the Prognosis of Cirrhosis with Acute Gastrointestinal Bleeding: A Retrospective Multicenter Study.

Abstract

IntroductionAcute gastrointestinal bleeding (GIB) is a major cause of death in liver cirrhosis. This multicenter study aims to develop and validate a novel and easy-to-access model for predicting the prognosis of patients with cirrhosis and acute GIB.MethodsPatients with cirrhosis and acute GIB were enrolled and randomly divided into the training (n = 865) and validation (n = 817) cohorts. In the training cohort, the independent predictors for in-hospital death were identified by logistic regression analyses, and then a new prognostic model (i.e., CAGIB score) was established. Area under curve (AUC) of CAGIB score was calculated by receiver operating characteristic curve analysis and compared with Child–Pugh, model for end-stage liver disease (MELD), MELD-Na, and neutrophil–lymphocyte ratio (NLR) scores.ResultsIn the training cohort, hepatocellular carcinoma (HCC), diabetes, total bilirubin (TBIL), albumin (ALB), alanine aminotransferase (ALT), and serum creatinine (Scr) were independent predictors of in-hospital death. CAGIB score = diabetes (yes = 1, no = 0) × 1.040 + HCC (yes = 1, no = 0) × 0.974 + TBIL (μmol/L) × 0.005 − ALB (g/L) × 0.091 + ALT (U/L) × 0.001 + Scr (μmol/L) × 0.012 − 3.964. In the training cohort, the AUC of CAGIB score for predicting in-hospital death was 0.829 (95% CI 0.801–0.854, P < 0.0001), which was higher than that of Child–Pugh (0.762, 95% CI 0.732–0.791), MELD (0.778, 95% CI 0.748–0.806), MELD-Na (0.765, 95% CI 0.735–0.793), and NLR (0.587, 95% CI 0.553–0.620) scores. In the validation cohort, the AUC of CAGIB score (0.714, 95% CI 0.682–0.746, P = 0.0006) remained higher than that of Child–Pugh (0.693, 95% CI 0.659–0.725), MELD (0.662, 95% CI 0.627–0.695), MELD-Na (0.660, 95% CI 0.626–0.694), and NLR (0.538, 95% CI 0.503–0.574) scores.ConclusionCAGIB score has a good predictive performance for prognosis of patients with cirrhosis and acute GIB.