Risk stratification in acute variceal bleeding: Far from an ideal score

Abstract

Acute variceal bleeding (AVB) results from rupture of esophageal or gastric varices. It is a lifethreatening complication of portal hypertension. Nevertheless, it remains unclear how to predict adverse outcomes and identify high-risk patients. In variceal hemorrhage, high Child-Turcotte-Pugh (Child) and Model for End-stage Liver Disease (MELD) scores are associated with a worse prognosis. The Rockall system (Rockall), Glasgow-Blatchford (Blatchford), and AIMS65 scores have been validated for risk stratification for nonvariceal upper gastrointestinal bleeding; however, their use is controversial in AVB. The aim of this study was to compare the performance of Child, MELD, Rockall, Blatchford, and AIMS65 scores in risk stratification for rebleeding and/ or mortality associated with AVB. METHODS: This retrospective study was conducted at a tertiary care hospital over 42 months. The outcomes were 6-week rebleeding and mortality. The AUROC was calculated for each score (1-0.9, 0.9-0.8, and 0.8-0.7, indicating excellent, good, and acceptable predictive power, respectively). RESULTS: In total, 222 patients were included. Six-week rebleeding and mortality rates were 14% and 18.5%, respectively. No score was useful for discriminating patients at a higher risk of rebleeding. The AUROCs were 0.59, 0.57, 0.61, 0.63, and 0.56 for Rockall, Blatchford, AIMS65, Child, and MELD scores, respectively. Prediction of 6-week mortality based on Rockall (AUROC 0.65), Blatchford (AUROC=0.60), and AIMS65 (AUROC=0.67) scores were also not considered acceptable. The AUROCs for predicting mortality were acceptable for Child and MELD scores (0.72 and 0.74, respectively). CONCLUSION: Rockall, Blatchford, and AIMS65 scores are not useful for predicting 6-week rebleeding or mortality in patients with AVB. Child and MELD scores can identify patients at higher risk for 6-week mortality but not for 6-week rebleeding.

A New Nomogram for Predicting the Risk of Intracranial Hemorrhage in Acute Ischemic Stroke Patients After Intravenous Thrombolysis

“…In addition, in our study, the AUC-ROC value obtained using the nomogram constructed by Zhou ( 12 ) was 0.663 in the training set and 0.662 in the testing set. When the AUC-ROC is <0.700, the discriminative power of the test is not statistically significant ( 26 – 28 ). The other nomogram comprised three variables: AF, NIHSS scores, and glucose level ( 17 ).…”

Usefulness of the d-dimer to albumin ratio for risk assessment in patients with acute variceal bleeding at the emergency department: retrospective observational study

“…Scoring that can predict poor outcomes in variceal bleeding, which is a disease-specific condition associated with upper gastrointestinal bleeding and cirrhosis, is focused on the prognosis of liver disease, as predicted by the MELD or Child–Pugh scores [ 2 ]. Existing upper gastrointestinal bleeding (UGIB) scores require various laboratory data and physical examination findings, such as history, ascites through ultrasonography, cardiac function evaluation, endoscopic findings, and dynamic blood pressure changes, heart rate, and level of consciousness [ 3 ]. In this study, as the scoring system in the ED was comparatively analyzed, the post endoscopic Rockall score was excluded from the outcome assessment.…”

“…The prognosis of patients with AVB is associated with liver-disease severity [ 2 ]. The Child–Pugh and model end-stage liver disease (MELD) scores have been traditionally used [ 3 ]. The Child–Pugh score predicts life expectancy and assesses the mortality percentage in patients with cirrhosis [ 4 ].…”

Nghiên cứu giá trị của thang điểm ALBI trong tiên lượng xuất huyết tiêu hóa cấp do vỡ giãn tĩnh mạch thực quản ở bệnh nhân xơ gan

“…222 BN nghiên cứu có tuổi trung bình 54,7 ± 10,4; nam giới chiếm đa số 94,1%, 90,5% có tiền sử xơ gan trước đây và 143 BN (64,4%) đã từng XHTH do vỡ giãn TMTQ. Kết quả nghiên cứu của chúng tôi phù hợp với kết quả của nhiều nghiên cứu cho thấy bệnh xơ gan thường gặp ở lứa tuổi trung niên, nam giới mắc bệnh nhiều hơn nữ giới và thường phải nhập viện nhiều lần do biến chứng, đặc biệt là biến chứng XHTH [3,5,6].…”

“…Nghiên cứu của Aluizio C.L. và CS (2021) trên 222 BN XHTH do vỡ TMTQ cho thấy tỷ lệ tái chảy máu sớm trong vòng 5 ngày đầu nhập viện là 4,5%, tỷ lệ tử vong 5,0%, khi theo dõi đến 6 tuần thì tỷ lệ tái chảy máu và tử vong đều tăng lên 18,5% [3] Kết quả bảng 3 cho thấy điểm ALBI trung bình ở nhóm nghiên cứu là -1,26 ± 0,63, chủ yếu gặp ở nhóm ALBI-2 và ALBI-3 (41,4% và 57,7%, theo thứ tự). Kết quả nghiên cứu của chúng tôi khá tương đồng với kết quả công bố của Elsafty R.E.…”