Abstract
BackgroundHepatic encephalopathy exacerbates the morbidity, delays hospital discharge, and increases the rate of readmissions of cirrhotic patients, particularly those are admitted by acute variceal bleeding. We evaluated the performance of albumin-bilirubin score in prediction of hepatic encephalopathy in cirrhotic patients with acute variceal bleeding, in comparison to Child-Pugh and MELD scores. This prospective cohort study was conducted on 250 cirrhotic patients who were consecutively presented by acute variceal bleeding in the period from January to December 2020 at Tanta university emergency hospital. Albumin-bilirubin, Child-Pugh, and MELD scores were measured at admission, and then all patients were followed up for 4 weeks after endoscopic bleeding control for possible occurrence of hepatic encephalopathyResultsAlbumin-bilirubin, Child-Pugh, and MELD scores had significant performances in prediction of hepatic encephalopathy in cirrhotic patients with acute variceal bleeding; in this regard, albumin-bilirubin score had the highest accuracy (AUC 0.858, CI 0.802-0.914, sig 0.000) followed by Child-Pugh score (AUC 0.654, CI 0.574–0.735, sig 0.001) and then MELD score (AUC 0.602, CI 0.519–0.686, sig 0.031). The cumulative incidence of hepatic encephalopathy in cirrhotic patients with albumin-bilirubin grade 3 was found to be significantly more than that present in albumin-bilirubin grade 2; most of these hepatic encephalopathy cases occurred in the first 2 weeks of follow-up period.ConclusionsAlbumin-bilirubin score has a significant performance in risk prediction of hepatic encephalopathy in cirrhotic patients with acute variceal bleeding better than Child-Pugh and MELD scores. Albumin-bilirubin grades could be used as a risk stratifying tool to triage cirrhotic patients who will benefit from early discharge after bleeding control and those patients who will benefit from prophylactic measures for hepatic encephalopathy.
Highlights
Hepatic encephalopathy exacerbates the morbidity, delays hospital discharge, and increases the rate of readmissions of cirrhotic patients, those are admitted by acute variceal bleeding
Exclusion and inclusion criteria Fifty-four patients were excluded as they did not fulfill study inclusion criteria (31 patients were excluded due to non-variceal upper GIT bleeding, 9 patients excluded as they were clinically unfit for upper GIT endoscopy, 10 patients were excluded due to failure of endoscopic control of variceal bleeding, 4 patients were excluded because cirrhosis was not confirmed), five patients were excluded as they were presented by hepatic encephalopathy before upper GIT endoscopy, three patients were excluded as they died shortly after admission during preoperative resuscitation, and seven patients were excluded as they refused follow-up in our unit
As regards the accuracy of ALBI score in prediction of Hepatic encephalopathy (HE) in cirrhotic patients with acute variceal bleeding (AVB) in comparison to both Child-Pugh and Modified end-stage liver disease (MELD) scores, we found that all of these scores had a significant performance; we found that ALBI score had the highest performance followed by Child-Pugh score MELD score
Summary
Hepatic encephalopathy exacerbates the morbidity, delays hospital discharge, and increases the rate of readmissions of cirrhotic patients, those are admitted by acute variceal bleeding. Elsafty et al Egyptian Liver Journal (2021) 11:18 model depends on two objectively evaluated parameters (serum albumin and serum bilirubin); it assesses the degree of underlying hepatic reserve function in cirrhotic patients and has a high degree of performance in prediction of mortality due to liver failure [9]. This score was widely validated in many reports [10,11,12,13]. We assessed the performance of albuminbilirubin score in prediction of hepatic encephalopathy in cirrhotic patients with acute variceal bleeding, in comparison to Child-Pugh and MELD scores
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