Published online Dec 7, 2019. doi: 10.3748/wjg.v25.i45.6668
Peer-review started: September 26, 2019
First decision: November 4, 2019
Revised: November 13, 2019
Accepted: November 16, 2019
Article in press: November 16, 2019
Published online: December 7, 2019
Several risk scoring systems have been developed and are regarded as useful tools for predicting clinical outcomes in patients with upper gastrointestinal bleeding (UGIB). As a common form of acute UGIB, patients with variceal bleeding often have an increased risk of in-hospital adverse outcomes. Data are limited regarding the predictive value of these risk scoring systems for patients with variceal bleeding.
Variceal bleeding is a serious complication of cirrhosis, and discovering valuable prognostic scores will be useful for early identification of high-risk patients. These patients will benefit if necessary measures are taken timely.
The present study aimed to validate the predictive value of eight scoring systems for in-hospital outcomes in cirrhotic patients with variceal bleeding.
Consecutive patients with acute variceal bleeding, from March 2017 to June 2019, were included at the Second Affiliated Hospital of Xi’an Jiaotong University. By reviewing medical records, required data were collected and prognostic scores were calculated for the clinical Rockall score (CRS), AIMS65 score (AIMS65), Glasgow-Blatchford score (GBS), modified GBS (mGBS), Canada-United Kingdom-Australia score (CANUKA), Child-Turcotte-Pugh score (CTP), model for end-stage liver disease (MELD) and MELD-Na. The discriminative ability of these prognostic scores was assessed using the area under the receiver operating characteristic curve (AUROC), and the calibration was evaluated by the Hosmer-Lemeshow (H-L) test.
We retrospectively enrolled 330 cirrhotic patients with variceal bleeding. The rate of in-hospital rebleeding for these patients was 20.3%, and the rate of in-hospital mortality was 10.6%. For predicting in-hospital rebleeding, although all AUROCs of these prognostic scores were statistically significant, only the AUROCs of the CTP and CRS were clinically acceptable (AUROC > 0.7). The calibration of all prognostic scores for in-hospital rebleeding was good. For predicting in-hospital mortality, all AUROCs of these prognostic scores were good with statistical significance, especially the CRS, CTP, AIMS65, MELD-Na and MELD (AUROCs > 0.8). The calibration of all prognostic scores for in-hospital mortality was also good.
The risk of in-hospital adverse outcomes remains high in cirrhotic patients with variceal bleeding. The CTP and CRS have acceptable abilities for predicting in-hospital rebleeding. All of these prognostic scores are useful for predicting in-hospital mortality, especially the CRS, CTP, AIMS65, MELD-Na and MELD. Clinicians from hospitals of different grades can select suitable models for early identification of high-risk patients.
The predictive value of these prognostic scores still need to be confirmed in patients with special risk factors, such as gastric variceal bleeding, high portal pressure and those receiving special treatments. Predictive models with high accuracy need to be established for predicting in-hospital rebleeding taking into account the limitations of existing models.