Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Mar 27, 2020; 12(3): 99-107
Published online Mar 27, 2020. doi: 10.4254/wjh.v12.i3.99
Platelet-albumin-bilirubin score - a predictor of outcome of acute variceal bleeding in patients with cirrhosis
Omar Elshaarawy, Naglaa Allam, Eman Abdelsameea, Asmaa Gomaa, Imam Waked
Omar Elshaarawy, Naglaa Allam, Eman Abdelsameea, Asmaa Gomaa, Imam Waked, Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin Elkom 32511, Egypt
Author contributions: Elshaarawy O and Abdelsameea E collected patient’s data; Elshaarawy O analyzed the data; all authors wrote the manuscript; Allam N and Waked I revised the manuscript.
Institutional review board statement: The study was approved by the institutional review board (IRB number IRB00003413).
Informed consent statement: Informed consent was obtained from all patients.
Conflict-of-interest statement: Imam Waked received grants/research supports or speaker’s honoraria from Abbvie, Marcyrl, MSD, Mylan, Onxio, and Pharco. The authors report no other conflicts of interest in this work.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: Eman Abdelsameea, MBChB, MD, MSc, Associate Professor, Doctor, Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin Elkom 32511, Egypt. eabdelsameea@liver-eg.org
Received: September 19, 2019
Peer-review started: September 19, 2019
First decision: October 14, 2019
Revised: January 7, 2020
Accepted: January 14, 2020
Article in press: January 14, 2020
Published online: March 27, 2020
Processing time: 186 Days and 20.9 Hours
Abstract
BACKGROUND

The albumin-bilirubin (ALBI) score was validated as a prognostic indicator in patients with liver disease and hepatocellular carcinoma. Incorporating platelet count in the platelet-albumin-bilirubin (PALBI) score improved validity in predicting outcome of patients undergoing resection and ablation.

AIM

To evaluate the PALBI score in predicting outcome of acute variceal bleeding in patients with cirrhosis.

METHODS

The data of 1517 patients with cirrhosis presenting with variceal bleeding were analyzed. Child Turcotte Pugh (CTP) class, Model of End-stage Liver Disease (MELD), ALBI and PALBI scores were calculated on admission, and were correlated to the outcome of variceal bleeding. Areas under the receiving-operator characteristic curve (AUROC) were calculated for survival and rebleeding.

RESULTS

Mean age was 52.6 years; 1176 were male (77.5%), 69 CTP-A (4.5%), 434 CTP-B (29.2%), 1014 CTP-C (66.8%); 306 PALBI-1 (20.2%), 285 PALBI-2 (18.8%), and 926 PALBI-3 (61.1%). Three hundred and thirty-two patients died during hospitalization (21.9%). Bleeding-related mortality occurred in 11% of CTP-B, 28% of CTP-C, in 21.8% of PALBI-2 and 34.4% of PALBI-3 patients. The AUROC for predicting survival of acute variceal bleeding was 0.668, 0.689, 0.803 and 0.871 for CTP, MELD, ALBI and PALBI scores, respectively. For predicting rebleeding the AUROC was 0.681, 0.74, 0.766 and 0.794 for CTP, MELD, ALBI and PALBI scores, respectively.

CONCLUSION

PALBI score on admission is a good prognostic indicator for patients with acute variceal bleeding and predicts early mortality and rebleeding.

Keywords: Variceal bleeding; Platelet-albumin-bilirubin score; Albumin-bilirubin score; Rebleeding

Core tip: This study describes a comparative analysis of the performance of different scoring systems in a large number of patients with acute variceal bleeding. The platelet-albumin-bilirubin score performed better in predicting short-term outcome and the incidence of rebleeding compared with the other 4 scoring systems, the Child Pugh score, albumin-bilirubin score and Model of End-stage Liver Disease and its modification for acute variceal bleeding.