Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2019; 25(45): 6668-6680
Published online Dec 7, 2019. doi: 10.3748/wjg.v25.i45.6668
Prognostic value of risk scoring systems for cirrhotic patients with variceal bleeding
Xin-Xing Tantai, Na Liu, Long-Bao Yang, Zhong-Cao Wei, Cai-Lan Xiao, Ya-Hua Song, Jin-Hai Wang
Xin-Xing Tantai, Na Liu, Long-Bao Yang, Zhong-Cao Wei, Cai-Lan Xiao, Ya-Hua Song, Jin-Hai Wang, Division of Gastroenterology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
Author contributions: Tantai XX, Wang JH and Liu N contributed to study concept and design; Xiao CL and Song YH contributed to data collection; Yang LB and Wei ZC contributed to data verification; Tantai XX, Wang JH and Liu N contributed to data management, interpretation and supervision; Tantai XX contributed to statistical analysis and drafted the manuscript; Tantai XX, Wang JH and Liu N contributed to critical revision of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of The Second Affiliated Hospital of Xi’an Jiaotong University.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jin-Hai Wang, MD, Professor, Division of Gastroenterology, The Second Affiliated Hospital, Xi’an Jiaotong University, No. 157, Xiwu Road, Xi’an 710004, Shaanxi Province, China. jinhaiwang@hotmail.com
Telephone: +86-29-87679335 Fax: +86-29-87679368
Received: September 26, 2019
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
Abstract
BACKGROUND

Acute variceal bleeding is one of the deadliest complications of cirrhosis, with a high risk of in-hospital rebleeding and mortality. Some risk scoring systems to predict clinical outcomes in patients with upper gastrointestinal bleeding have been developed. However, for cirrhotic patients with variceal bleeding, data regarding the predictive value of these prognostic scores in predicting in-hospital outcomes are limited and controversial.

AIM

To validate and compare the overall performance of selected prognostic scoring systems for predicting in-hospital outcomes in cirrhotic patients with variceal bleeding.

METHODS

From March 2017 to June 2019, cirrhotic patients with acute variceal bleeding were retrospectively enrolled at the Second Affiliated Hospital of Xi’an Jiaotong University. 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 were calculated. The overall performance of these prognostic scoring systems was evaluated.

RESULTS

A total of 330 cirrhotic patients with variceal bleeding were enrolled; the rates of in-hospital rebleeding and mortality were 20.3% and 10.6%, respectively. For in-hospital rebleeding, the discriminative ability of the CTP and CRS were clinically acceptable, with area under the receiver operating characteristic curves (AUROCs) of 0.717 (0.648-0.787) and 0.716 (0.638-0.793), respectively. The other tested scoring systems had poor discriminative ability (AUROCs < 0.7). For in-hospital mortality, the CRS, CTP, AIMS65, MELD-Na and MELD showed excellent discriminative ability (AUROCs > 0.8). The AUROCs of the mGBS, CANUKA and GBS were relatively small, but clinically acceptable (AUROCs > 0.7). Furthermore, the calibration of all scoring systems was good for either in-hospital rebleeding or death.

CONCLUSION

For cirrhotic patients with variceal bleeding, in-hospital rebleeding and mortality rates remain high. The CTP and CRS can be used clinically to predict in-hospital rebleeding. The performances of the CRS, CTP, AIMS65, MELD-Na and MELD are excellent at predicting in-hospital mortality.

Keywords: Cirrhosis, Variceal bleeding, Rebleeding, Mortality, Risk score

Core tip: Acute variceal bleeding is one of the most serious complications of cirrhotic patients with a high risk of in-hospital rebleeding and mortality. This study validated and compared the overall performance of eight prognostic scores for predicting in-hospital adverse outcomes in cirrhotic patients with variceal bleeding. We screened out some useful prognostic scores for predicting in-hospital adverse outcomes, especially for predicting in-hospital mortality. These prognostic scores can be easily used for early identification of high-risk patients. For high-risk patients, a transfer to a better hospital, close monitoring and aggressive treatments can help to reduce the risk of in-hospital adverse outcomes.