PERFORMANCE OF BLEEDING RISK SCORES AND NON-INVASIVE LIVER FUNCTION TESTS IN PREDICTING SIX-WEEK MORTALITY IN ACUTE VARICEAL BLEEDING

Aims We aimed to evaluate the performance of bleeding-risk scores and non-invasive liver function tests in predicting six-week mortality in acute variceal bleeding(AVB).

Methods This was a retrospective study including consecutive cirrhotic patients hospitalized for an AVB from January 2010 to December 2019. The following bleeding-risk scores were calculated: GB score, AIMS65, and APASL. The following non-invasive tests were calculated: CHILD-Pugh, MELD, Lok-index, cirrhosis discriminant index(CDS), albumin-bilirubin grade(ALBI), platelet-albumin-bilirubin grade(PALBI), fibrosis-index based on 4factors(FIB-4), aspartate-aminotransferase-to-platelet ratio(APRI), King’s score, Goteborg-University Cirrhosis Index(GUCI), and aspartate-aminotransferase to an alanine-aminotransferase ratio(AAR).

Results A total of 224 patients were included with a mean age of 61.02±13.21 years and a sex-ratio of1.60. These patients were admitted 518 times to our department for acute decompensation. One-hundred-forty-three admissions were related to AVB(27.6%). The six-week mortality rate was 25.7%. The following scores have been statistically associated with sex-week mortality: AIMS65(p=0.001), APASL(p=0.002), GB score(p<0.001), FIB-4(p=0.003), ALBI(p=0,023), PALBI(p=0,037), King's score(p=0,039) and CHILD score(p=0,043). AIMS65 had the best area under the ROC curve(AUROC) 0.877[95%CI:0.761-0.993)] followed by APASL (AUROC=0.847[95%CI:0.715–0.978)]), ALBI (AUROC=0.804 [95%CI:0.609-0.999]), PALBI (AUROC=0.757[95%CI:0.4900.999]), the GB score (AUROC=0.747[95%CI:0.527-0.966)]), and CHILD score (AUROC=0.601[95%CI:0.331–0.872]. At the threshold of1,5, AIMS65 had a sensitivity and specificity of 99% and 70,1% respectively. At the cut-off of-1,37, ALBI had a sensibility and specificity of 75% and 70.3% respectively in predicting six-week mortality.

Conclusions Bleeding-risk scores had the best prognostic value in patients with AVB, in particular, AIMS65 at the threshold of1.5. This simple score would allow a better selection of vulnerable patients.

Publication History

Article published online:
14 April 2022