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.
Highlights
Acute variceal bleeding is a frequent medical emergency with the 6-week mortality of 15-20% in patients with liver cirrhosis [1, 2]
Multiple scoring systems have been proposed about liver diseases or acute upper gastrointestinal bleeding, very limited data are available for the prognostic value of current scoring systems in patients with acute variceal bleeding
In the whole cohort including Hepatocellular carcinoma (HCC) patients, the Area under curves (AUCs) of Child-Pugh, cirrhosis acute gastrointestinal bleeding (CAGIB), model for end-stage liver disease (MELD), and neutrophil-lymphocyte ratio (NLR) scores were 0.842, 0.840, 0.798, and 0.688, respectively (Figure 2)
Summary
Acute variceal bleeding is a frequent medical emergency with the 6-week mortality of 15-20% in patients with liver cirrhosis [1, 2]. Conventional scoring systems with acute upper gastrointestinal bleeding included Glasgow-Blatchford score (GBS), Rockall score, and AIMS65 score [6,7,8] These systems were not designed for patients with cirrhosis. Robertson et al validated the AIMS65 score and found that AMIS65 score was equivalent to other liver disease severity risk stratification scores in predicting short term mortality [13] These scoring systems were designed for acute upper gastrointestinal bleeding rather than for liver cirrhosis patients with acute variceal bleeding. 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. Child-Pugh and CAGIB scores showed better predictive performance for prognosis of patients with cirrhosis and acute variceal bleeding than NLR scores
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