Brief Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Apr 28, 2011; 17(16): 2120-2125
Published online Apr 28, 2011. doi: 10.3748/wjg.v17.i16.2120
MELD score can predict early mortality in patients with rebleeding after band ligation for variceal bleeding
Wei-Ting Chen, Chun-Yen Lin, I-shyan Sheen, Chang-Wen Huang, Tsung-Nan Lin, Chun-Jung Lin, Wen-Juei Jeng, Chien-Hao Huang, Yu-Pin Ho, Cheng-Tang Chiu
Wei-Ting Chen, Chun-Yen Lin, Chang-Wen Huang, Tsung-Nan Lin, Chun-Jung Lin, Wen-Juei Jeng, Chien-Hao Huang, Yu-Pin Ho, Cheng-Tang Chiu, I-Shyan Sheen, Department of Hepato-Gastroenterology, Linkou Medical Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taipei, Taiwan, China
Author Contributions: Ho YP and Chiu CT designed the research; Chen WT, Jeng WJ and Huang CH performed data collection; Chen WT, Lin CY and Ho YP analyzed and interpreted the data; Chen WT, Ho YP and Lin CJ wrote the manuscript; Lin CY and Sheen IS contributed critical revision of the manuscript for important intellectual content; Huang CW contributed statistical analysis; Lin CJ provided material support; the final version of the manuscript was approved by all authors.
Correspondence to: Yu-Pin Ho, MD, Assistant Professor, Department of Hepato-Gastroenterology, Linkou Medical Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 5 Fu-Shin Street, Kweishan, Taoyuan 333, Taipei, Taiwan, China. hoyupin@gmail.com
Telephone: +886-3-3281200 Fax: +886-3-3272236
Received: October 7, 2010
Revised: December 1, 2010
Accepted: December 8, 2010
Published online: April 28, 2011
Abstract

AIM: To investigate the outcomes, as well as risk factors for 6-wk mortality, in patients with early rebleeding after endoscopic variceal band ligation (EVL) for esophageal variceal hemorrhage (EVH).

METHODS: Among 817 EVL procedures performed for EVH between January 2007 and December 2008, 128 patients with early rebleeding, defined as rebleeding within 6 wk after EVL, were enrolled for analysis.

RESULT: The rate of early rebleeding after EVL for acute EVH was 15.6% (128/817). The 5-d, 6-wk, 3-mo, and 6-mo mortality rates were 7.8%, 38.3%, 55.5%, and 58.6%, respectively, in these early rebleeding patients. The use of beta-blockers, occurrence of hypovolemic shock, and higher model for end-stage liver disease (MELD) score at the time of rebleeding were independent predictors for 6-wk mortality. A cut-off value of 21.5 for the MELD score was found with an area under ROC curve of 0.862 (P < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value were 77.6%, 81%, 71.7%, and 85.3%, respectively. As for the 6-mo survival rate, patients with a MELD score ≥ 21.5 had a significantly lower survival rate than patients with a MELD score < 21.5 (P < 0.001).

CONCLUSION: This study demonstrated that the MELD score is an easy and powerful predictor for 6-wk mortality and outcomes of patients with early rebleeding after EVL for EVH.

Keywords: Model for end-stage liver disease score, Esophageal variceal hemorrhage, Rebleeding, Cirrhosis, Mortality