MELD score can predict early mortality in patients with rebleeding after band ligation for variceal bleeding

Table 1 Characteristics of patients with rebleeding after endoscopic variceal band ligation for esophageal varices bleeding (mean ± SD) n (%)

Variable	Overall (n = 128)
Sex (male/female)	107 (83.6)/21 (16.4)
Age (yr)	53.6 ± 13.9
Etiology
Virus	61 (47.7)
Alcohol	31 (24.2)
Virus + alcohol	28 (21.9)
Others	8 (6.2)
Index EGD finding
Active EV bleeding	39 (30.5)
Blood in lumen	49 (38.3)
Clean	40 (31.2)
Duration between rebleeding and Index EVL	14.0 (10.8)
1-5 d	33 (25.8)
6-42 d	95 (74.2)
Index EVL
CTP score	9.8 ± 2.3
CTP classification
A	12 (9.40)
B	44 (34.4)
C	72 (56.2)
MELD	19.8 ± 8.9
Rebleeding
CTP score	10.1 ± 2.6
CTP classification
A	14 (10.9)
B	36 (28.1)
C	78 (60.9)
MELD	21.4 ± 9.8

EVL: Endoscopic variceal band ligation; EV: Esophageal varices; CTP: Child-turcotte-pugh; MELD: Model for end-stage liver disease; EGD: Esophagogastroduodenoscopy.

Table 2 Rebleeding focus, therapy and outcome of patients with rebleeding after endoscopic variceal band ligation for esophageal varices bleeding n (%)

	Overall (n = 128)
Rebleeding focus
EV bleeding	75 (58.6)
Post-EVL ulcer bleeding	24 (18.8)
GV bleeding	7 (5.5)
Peptic ulcer bleeding	11 (8.6)
PHG	11 (8.6)
Therapy for rebleeding
Endoscopic and pharmacologic therapy	92 (71.9)
Pharmacologic therapy only	35 (27.3)
Surgery	1 (0.8)
Rebleeding 5-d failure	24 (18.8)
Uncontrolled bleeding and died within 5 d	8 (6.3)
Died of non-bleeding cause	2 (1.6)
Recurrent bleeding within 5 d	14 (10.9)
5-d mortality	10 (7.8)
6-wk mortality	49 (38.3)
6-wk mortality causes
Sepsis-induced multi-organ failure	26 (53.1)
GI bleeding	18 (36.7)
Liver failure	5 (10.2)
3-mo mortality	71 (55.5)
6-mo mortality	75 (58.6)

EV: Esophageal varices; EVL: Endoscopic variceal band ligation; GV: Gastric varices; PHG: Portal hypertensive gastropathy; GI: Gastrointestinal.

Table 3 Variables associated with 6-wk mortality in patients with rebleeding after endoscopic variceal band ligation for esophageal varices bleeding (mean ± SD) n (%)

Variable	6-wk mortality (n = 49, 38.3%)	6-wk survival (n = 79, 61.7%)	P-value
Sex (male/female)	40 (81.6)/9 (18.8)	67 (84.8)/12 (17.6)	0.637
Age (yr)	53.3 ± 13.3	53.7 ± 14.3	0.866
Etiology			0.683
Virus	23 (46.9)	38 (48.1)
Alcohol	11 (22.4)	20 (25.3)
Virus + alcohol	13 (26.5)	15 (19.0)
Others	2 (4.1)	6 (7.6)
HCC			0.291
No or small	29 (59.2)	54 (68.4)
Advanced	20 (40.8)	25 (31.6)
PVT			0.786
Main trunk	12 (24.5)	18 (22.8)
Branch	5 (10.2)	9 (11.4)
Duration between rebleeding and index EVL	12.8 ± 9.0	14.7 ± 11.7	0.528
1-5 d	13 (26.5)	20 (25.3)	0.879
6-42 d	36 (73.5)	59 (74.7)
Rebleeding laboratory findings
CTP score	11.9 ± 1.9	8.9 ± 2.3	0.000
CTP classification
A	1 (2.0)	13 (16.5)	0.017
B	3 (6.1)	33 (41.8)	0.000
C	45 (91.8)	33 (41.8)	0.000
MELD score	28.9 ± 9.0	16.8 ± 7.0	0.000
HE (grade)	1.3 ± 1.5	0.3 ± 0.8	0.000
Cr (μmol/L)	203.3 ± 159.1	114.9 ± 97.2	0.000
Na (mmol/L)	138.7 ± 9.6	134.6 ± 14.3	0.084
K (mmol/L)	4.2 ± 1.0	3.9 ± 0.9	0.171
Bil (μmol/L)	263.3 ± 236.0	90.6 ± 135.1	0.000
Alb (g/L)	25 ± 5	29 ± 6	0.000
Hb (g/L)	83 ± 18	90 ± 17	0.041
WBC (109/L)	12.5 ± 6.4	8.2 ± 4.7	0.000
Platelets (109/L)	102.4 ± 69.2	101.0 ± 72.3	0.915
INR (PT)	2.2 ± 0.9	1.5 (0.4)	0.000
Rebleeding 5-d failure	18 (36.7)	6 (7.6)	0.000
Died within 5 d	10	0	0.000
Recurrent bleeding within 5 d	8	6	0.150
Hypovolemic shock	21 (42.9)	3 (3.8)	0.000
Rebleeding focus			0.500
EV bleeding	28 (57.1)	47 (59.5)
Post-EVL ulcer bleeding	9 (18.4)	15 (19.0)
GV bleeding	3 (6.1)	4 (5.1)
Peptic ulcer bleeding	6 (12.2)	5 (6.3)
PHG	3 (6.1)	8 (10.1)
Rebleeding EGD finding			0.019
Active bleeding	20 (40.8)	30 (38.0)
Blood in lumen	25 (51.0)	27 (34.2)
Clean	4 (8.2)	22 (27.8)
EGD Tx			0716
Endoscopic therapy + medical	36 (73.5)	56 (70.9)
Medical therapy only	13 (26.5)	22 (27.8)
Surgery	0 (0.0)	1 (1.3)
Rebleeding infection	42 (85.7)	36 (45.6)	0.000
Rebleeding antibiotic use	35 (71.4)	46 (58.2)	0.132
Rebleeding Inderal use	8 (16.3)	37 (46.8)	0.000

The P-values were calculated by using Student’s t-test for continuous variables and χ² test for categorical variables. EV: Esophageal varices; EVL: Endoscopic variceal band ligation; HCC: Hepatocellular carcinoma; PVT: Portal vein thrombosis; CTP: Child-turcotte-pugh; MELD: Model for end-stage liver disease; INR (PT): International normalised ratio of a patient's prothrombin time to a normal control sample; PHG: portal hypertensive gastropathy; EGD: Esophagogastroduodenoscopy; GV: Gastric varices.

Table 4 Logistic regression models for variables associated with 6-wk mortality in patients with rebleeding after endoscopic variceal band ligation for esophageal varices bleeding

Variables	UV		MV
	Estimate	P-value	Estimate	OR	95% CI	P-value
Rebleeding laboratory
CTP score	0.61	< 0.001
MELD score	0.17	< 0.001	0.16	1.17	1.10-1.25	< 0.001
HE (grade)	0.76	< 0.001
Cr	0.61	0.001
Bil	0.09	< 0.001
Alb	-1.18	0.001
Hb	-0.23	0.045
WBC	0.15	< 0.001
INR (PT)	1.85	< 0.001
Rebleeding 5-d failure	1.96	< 0.001
Hypovolemic shock	2.94	< 0.001	2.23	9.25	1.68-50.93	0.011
Rebleeding EGD finding	-1.47	0.011
Rebleeding infection	1.97	< 0.001
Rebleeding Inderal use	-1.51	0.001	-1.7	0.18	0.05-0.63	0.007

UV: Univariate analysis; MV: Multivariate analysis; CTP: Child-turcotte-pugh; MELD: Model for end-stage liver disease; HE: Hepatic encephalopathy; INR (PT): International normalised ratio of a patient's prothrombin time to a normal control sample; EGD: Esophagogastroduodenoscopy.

Table 5 Sensitivity, specificity, positive predictive value, and negative predictive value for predicting 6-wk mortality in patients with rebleeding after endoscopic variceal band ligation for esophageal varices bleeding n (%)

6-wk mortality	Sensitivity	Specificity	PPV	NPV
MELD score ≥ 21.5	77.55	81.01	71.7	85.33
Hypovolemic shock (+)	42.86	96.20	87.5	26.92
Beta-blocker use after rebleeding	83.67	46.84	49.4	82.22

PPV: Positive predictive value; NPV: Negative predictive value; MELD: Model for end-stage liver disease.