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
Processing time: 71 Days and 3.4 Hours
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

The present study aimed to validate the predictive value of eight scoring systems for in-hospital outcomes in cirrhotic patients with variceal bleeding.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.