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©The Author(s) 2019.
World J Gastroenterol. Dec 7, 2019; 25(45): 6668-6680
Published online Dec 7, 2019. doi: 10.3748/wjg.v25.i45.6668
Published online Dec 7, 2019. doi: 10.3748/wjg.v25.i45.6668
Table 1 Baseline characteristics of the included patients
Variables | Value |
No. of patients | 330 |
Age, mean ± SD, yr | 54.9 ± 12.7 |
Male sex, n (%) | 203 (61.5) |
Etiology, n (%) | |
Viral | 229 (69.4) |
Alcohol | 21 (6.4) |
Autoimmune | 34 (10.3) |
Other | 46 (13.9) |
Laboratory tests, median (IQR) | |
White blood cells (109/L) | 5.4 (3.6-7.8) |
Hemoglobin (g/L) | 80 (66-95) |
Platelets (109/L) | 77 (51-115) |
INR | 1.2 (1.1-1.4) |
Total bilirubin (µmol/L) | 22.6 (16.1-34.8) |
ALT (IU/L) | 23 (15-38) |
AST (IU/L) | 35 (25-56) |
Albumin (g/L) | 31.8 (28.4-35.3) |
BUN (mmol/L) | 8.7 (6.1-12.4) |
Creatinine (µmol/L) | 62.2 (48.5-77.2) |
Sodium (mmol/L) | 138.0 (134.9-140.3) |
Vital signs, median (IQR) | |
SBP (mmHg) | 110 (98-120) |
DBP (mmHg) | 65 (57-72) |
Heart rate (beats/min) | 88 (76-101) |
Location of variceal bleeding, n (%) | |
Esophageal varices | 295 (89.4) |
Gastric varices | 35 (10.6) |
Grading of esophageal varices | |
Mild/ moderate/severe, n (%) | 2 (0.7)/44 (14.9)/249 (84.4) |
Types of gastric varices | |
GOV2/IGV1, n (%) | 22 (62.9)/13 (37.1) |
Ascites, n (%) | 233 (70.6) |
Hepatic encephalopathy, n (%) | 28 (8.5) |
Hepatocellular carcinoma, n (%) | 73 (22.1) |
Bacterial infection, n (%) | 63 (19.1) |
Portal vein thrombosis, n (%) | 97 (29.4) |
Hospital intervention, n (%) | |
Endoscopic therapy | 141 (42.7) |
TIPSS | 21 (6.4) |
Surgery | 21 (6.4) |
Charlson comorbidity index > 6, n (%) | 45 (13.6) |
Hospital stay (d), median (IQR) | 13 (9-20) |
Scoring system, median (IQR) | |
CTP | 7 (6-9) |
CTP grade A/B/C, n (%) | 101 (30.6)/187 (56.7)/42 (12.7) |
MELD | 10 (9-13) |
MELD-Na | 12 (10-16) |
CRS | 2 (1-3) |
GBS | 12 (9-14) |
mGBS | 9 (7-11) |
AIMS65 | 1 (0-1) |
CANUKA | 10 (8-12) |
Table 2 Clinical outcomes of the study population, n (%)
Outcomes | Value |
In-hospital rebleeding | 67 (20.3) |
Admission to rebleeding (time interval, days), median (IQR) | 5 (3-8) |
Rebleeding occurred within 3 d | 27 (40.3) |
Rebleeding occurred within 7 d | 47 (70.1) |
Rebleeding occurred beyond 7 d | 20 (29.9) |
In-hospital mortality | 35 (10.6) |
In-hospital mortality with rebleeding | 17 (25.4) |
In-hospital mortality without rebleeding | 18 (6.8) |
In-hospital adverse outcomes | 85 (25.8) |
Table 3 Discrimination and calibration assessments of all the scoring systems for in-hospital adverse outcomes
Score | AUROC | 95%CI | P value | AUROC difference | 95%CI | P value | H-L test, P value |
In-hospital rebleeding | |||||||
CTP | 0.717 | 0.648-0.787 | < 0.001 | Reference | 0.134 | ||
CRS | 0.716 | 0.638-0.793 | < 0.001 | 0.0016 | -0.0851-0.0883 | 0.9713 | 0.062 |
MELD-Na | 0.680 | 0.609-0.752 | < 0.001 | 0.0369 | -0.0266-0.1000 | 0.2547 | 0.613 |
MELD | 0.661 | 0.588-0.734 | < 0.001 | 0.0560 | -0.0026-0.1150 | 0.0610 | 0.386 |
CANUKA | 0.656 | 0.579-0.732 | < 0.001 | 0.0614 | -0.0237- 0.1470 | 0.1575 | 0.186 |
AIMS65 | 0.642 | 0.565-0.719 | < 0.001 | 0.0753 | 0.0120 - 0.1380 | 0.0196 | 0.321 |
GBS | 0.617 | 0.534-0.699 | 0.003 | 0.1010 | 0.0153 - 0.1860 | 0.0208 | 0.041 |
mGBS | 0.600 | 0.518-0.683 | 0.011 | 0.1170 | 0.0314 - 0.2020 | 0.0074 | 0.064 |
In-hospital mortality | |||||||
CRS | 0.883 | 0.822-0.943 | < 0.001 | Reference | 0.166 | ||
CTP | 0.878 | 0.825-0.931 | < 0.001 | 0.0047 | -0.0620-0.0714 | 0.8901 | 0.566 |
AIMS65 | 0.856 | 0.787-0.925 | < 0.001 | 0.0269 | -0.0390-0.0928 | 0.4232 | 0.175 |
MELD-Na | 0.856 | 0.786-0.925 | < 0.001 | 0.0271 | -0.0453-0.0995 | 0.4630 | 0.636 |
MELD | 0.840 | 0.767-0.914 | < 0.001 | 0.0423 | -0.0360- 0.1210 | 0.2900 | 0.472 |
mGBS | 0.734 | 0.631-0.838 | < 0.001 | 0.1480 | 0.0552-0.2420 | 0.0018 | 0.013 |
CANUKA | 0.728 | 0.627-0.830 | < 0.001 | 0.1540 | 0.0675-0.2410 | 0.0005 | 0.046 |
GBS | 0.723 | 0.621-0.826 | < 0.001 | 0.1590 | 0.0668-0.2520 | 0.0007 | 0.004 |
In-hospital adverse outcomes | |||||||
CTP | 0.784 | 0.725-0.843 | < 0.001 | Reference | 0.218 | ||
CRS | 0.775 | 0.709-0.841 | < 0.001 | 0.0087 | -0.0650-0.0824 | 0.8171 | 0.002 |
MELD-Na | 0.739 | 0.675-0.803 | < 0.001 | 0.0446 | -0.0136-0.1030 | 0.1335 | 0.723 |
MELD | 0.724 | 0.659-0.789 | < 0.001 | 0.0598 | 0.0074-0.1120 | 0.0254 | 0.464 |
AIMS65 | 0.711 | 0.642-0.780 | < 0.001 | 0.0728 | 0.0160-0.1300 | 0.0120 | 0.101 |
CANUKA | 0.677 | 0.606-0.748 | < 0.001 | 0.1070 | 0.0274-0.1860 | 0.0084 | 0.023 |
GBS | 0.656 | 0.582-0.729 | < 0.001 | 0.1280 | 0.0516-0.2050 | 0.0010 | 0.008 |
mGBS | 0.649 | 0.574-0.723 | < 0.001 | 0.1350 | 0.0586-0.2120 | 0.0005 | 0.024 |
Table 4 The predictive value indices for predicting in-hospital adverse outcomes in clinically useful scoring systems
Score | Youdenindex | Cut-off | SEN | 95%CI | SPE | 95%CI | PPV | 95%CI | NPV | 95%CI |
In-hospital rebleeding | ||||||||||
CTP | 0.3851 | > 7 | 74.6 | 62.5-84.5 | 63.9 | 57.8-69.7 | 34.5 | 29.8-39.4 | 90.8 | 86.6-93.8 |
CRS | 0.3982 | > 2 | 65.7 | 53.1-76.8 | 74.1 | 68.4-79.3 | 39.3 | 33.1-45.8 | 89.4 | 85.8-92.2 |
In-hospital mortality | ||||||||||
CRS | 0.6751 | > 2 | 94.3 | 80.8-99.3 | 73.2 | 67.8-78.2 | 29.5 | 25.4-33.9 | 99.1 | 96.6-99.8 |
CTP | 0.5632 | > 7 | 94.3 | 80.8-99.3 | 62.0 | 56.2-67.6 | 22.8 | 20.0-25.8 | 98.9 | 96.0-99.7 |
AIMS65 | 0.6339 | > 1 | 80.0 | 63.1-91.6 | 83.4 | 78.6-87.5 | 36.4 | 29.6-43.7 | 97.2 | 94.8-98.6 |
MELD-Na | 0.5685 | > 17 | 71.4 | 53.7-85.4 | 85.4 | 80.9-89.2 | 36.8 | 29.1-45.1 | 96.2 | 93.7-97.7 |
MELD | 0.5157 | > 12 | 74.3 | 56.7-87.5 | 77.3 | 72.1-81.9 | 28.0 | 22.6-34.1 | 96.2 | 93.5-97.8 |
mGBS | 0.4349 | > 10 | 68.6 | 50.7-83.1 | 74.9 | 69.6-79.8 | 24.5 | 19.4-30.4 | 95.3 | 92.5-97.1 |
CANUKA | 0.3521 | > 12 | 45.7 | 28.8-63.4 | 89.5 | 85.4-92.7 | 34.0 | 24.0-45.8 | 93.3 | 91.1-95.0 |
GBS | 0.3700 | > 12 | 74.3 | 56.7-87.5 | 62.7 | 56.9-68.2 | 19.1 | 15.6-23.2 | 95.4 | 92.1-97.3 |
In-hospital adverse outcomes | ||||||||||
CTP | 0.4699 | > 7 | 78.8 | 68.6-86.9 | 68.2 | 61.9-73.9 | 46.2 | 41.0-51.5 | 90.3 | 85.9-93.4 |
CRS | 0.5095 | > 2 | 71.8 | 61.0-81.0 | 79.2 | 73.6-84.1 | 54.5 | 47.5-61.2 | 89.0 | 85.1-91.9 |
MELD-Na | 0.3758 | > 13 | 69.4 | 58.5-79.0 | 68.2 | 61.9-73.9 | 43.1 | 37.5-48.8 | 86.5 | 82.2-89.9 |
MELD | 0.3241 | > 13 | 45.9 | 35.0-57.0 | 86.5 | 81.6-90.5 | 54.2 | 44.4-63.6 | 82.2 | 79.0-84.9 |
AIMS65 | 0.3830 | > 1 | 51.8 | 40.7-62.7 | 86.5 | 81.6-90.5 | 57.1 | 47.7-66.1 | 83.8 | 80.5-86.6 |
- Citation: Tantai XX, Liu N, Yang LB, Wei ZC, Xiao CL, Song YH, Wang JH. Prognostic value of risk scoring systems for cirrhotic patients with variceal bleeding. World J Gastroenterol 2019; 25(45): 6668-6680
- URL: https://www.wjgnet.com/1007-9327/full/v25/i45/6668.htm
- DOI: https://dx.doi.org/10.3748/wjg.v25.i45.6668