Predictive value of BioCliM index on one-year and two-year prognosis in esophageal and gastric varices bleeding treated by endoscopic therapies

Abstract

Objective To assess the predictive value for survival of BioCliM index in liver cirrhosis caused esophageal and gastric varices bleeding (EGVB) treated by endoscopic variceal ligation (EVL), endoscopic injection sclerotherapy (EIS) and endoscopic tissue adhesives (ETA). Methods From December 2006 to December 2011, the clinical data of 166 hospitalized patients with first occurrence of EGVB caused by liver cirrhosis and received endoscopic therapies were retrospectively analyzed. The scores of model for end-stage liver disease (MELD), model for end-stage liver disease-Na (MELD-Na), BioCliM index and Child-Turcotte-Pugh (CTP) were calculated. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were applied to assess the accuracy of the four models in one-year and two-year prognosis evaluation, and to obtain the best critical value, and the mortality rates were compared among groups. Chi-square test, t test and rank-sum test were performed for statistical analysis. Results Among 166 patients, the levels of creatinine, bilirubin, albumin, sodium, international normalized ratio and prothrombin time were (0.10±0.06) mmol/L, (0.02±0.01) mmol/L, (30.13±5.06) g/L, (139.13±4.27) mmol/L, 1.50±0.32 and (17.83±2.88) s, respectively. During the one-year and two-year follow-up, there were 14 patients and 23 patients dead, respectively. During the one-year and two-year follow-up, the incidences of portal thrombosis of death group were lower than those of survival group (10/14 vs 93.4%, 142/152; 73.9%, 17/23 vs 94.4%, 135/143); and the differences were statistically significant (χ2=8.029 and 10.774, both P 0.05). The best critical value of BioCliM index was -0.234. Followed up for one year and two years, the mortality rates of patients with BioCliM index over -0.230 were higher than that of patients with BioCliM index less than -0.234 (31.0%, 9/29 vs 3.6%, 5/137; 34.5%, 10/29 vs 9.5%, 13/137); and the differences were statistically significant ( χ2=23.242 and 12.526, both P<0.01). Conclusions BioCliM index has a high accuracy in one-year and two-year mortality rate evaluation in liver cirrhosis patients with EGVB and received endoscopical therapies. We should pay attention to the prognosis evaluation before the endoscopical therapy. Key words: Liver cirrhosis; Esophageal and gastric varices; Hemorrhage; Endoscopy; Prognosis; End-stage liver disease model; BioCliM