Your browser doesn't support javascript.
loading
Risk stratification in acute variceal bleeding: Far from an ideal score
Aluizio, Carla Luiza de Souza; Montes, Ciro Garcia; Reis, Glaucia Fernanda Soares Ruppert; Nagasako, Cristiane Kibune.
  • Aluizio, Carla Luiza de Souza; Universidade Estadual de Campinas (FCM/UNICAMP). Departamento de Clinica Medica, Faculdade de Ciencias Medicas. Divisao de Gastroenterologia. Campinas. BR
  • Montes, Ciro Garcia; Universidade Estadual de Campinas (FCM/UNICAMP). Departamento de Clinica Medica, Faculdade de Ciencias Medicas. Divisao de Gastroenterologia. Campinas. BR
  • Reis, Glaucia Fernanda Soares Ruppert; Universidade Estadual de Campinas (FCM/UNICAMP). Departamento de Clinica Medica, Faculdade de Ciencias Medicas. Divisao de Gastroenterologia. Campinas. BR
  • Nagasako, Cristiane Kibune; Universidade Estadual de Campinas (FCM/UNICAMP). Departamento de Clinica Medica, Faculdade de Ciencias Medicas. Divisao de Gastroenterologia. Campinas. BR
Clinics ; 76: e2921, 2021. tab, graf
Article in English | LILACS | ID: biblio-1278928
ABSTRACT

OBJECTIVES:

Acute variceal bleeding (AVB) results from rupture of esophageal or gastric varices. It is a life-threatening complication of portal hypertension. Nevertheless, it remains unclear how to predict adverse outcomes and identify high-risk patients. In variceal hemorrhage, high Child-Turcotte-Pugh (Child) and Model for End-stage Liver Disease (MELD) scores are associated with a worse prognosis. The Rockall system (Rockall), Glasgow-Blatchford (Blatchford), and AIMS65 scores have been validated for risk stratification for nonvariceal upper gastrointestinal bleeding; however, their use is controversial in AVB. The aim of this study was to compare the performance of Child, MELD, Rockall, Blatchford, and AIMS65 scores in risk stratification for rebleeding and/or mortality associated with AVB.

METHODS:

This retrospective study was conducted at a tertiary care hospital over 42 months. The outcomes were 6-week rebleeding and mortality. The AUROC was calculated for each score (1-0.9, 0.9-0.8, and 0.8-0.7, indicating excellent, good, and acceptable predictive power, respectively).

RESULTS:

In total, 222 patients were included. Six-week rebleeding and mortality rates were 14% and 18.5%, respectively. No score was useful for discriminating patients at a higher risk of rebleeding. The AUROCs were 0.59, 0.57, 0.61, 0.63, and 0.56 for Rockall, Blatchford, AIMS65, Child, and MELD scores, respectively. Prediction of 6-week mortality based on Rockall (AUROC 0.65), Blatchford (AUROC=0.60), and AIMS65 (AUROC=0.67) scores were also not considered acceptable. The AUROCs for predicting mortality were acceptable for Child and MELD scores (0.72 and 0.74, respectively).

CONCLUSION:

Rockall, Blatchford, and AIMS65 scores are not useful for predicting 6-week rebleeding or mortality in patients with AVB. Child and MELD scores can identify patients at higher risk for 6-week mortality but not for 6-week rebleeding.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Esophageal and Gastric Varices / End Stage Liver Disease Type of study: Diagnostic study / Etiology study / Observational study / Prognostic study / Risk factors Limits: Humans Language: English Journal: Clinics Journal subject: Medicine Year: 2021 Type: Article Affiliation country: Brazil Institution/Affiliation country: UNICAMP)+BR

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Index: LILACS (Americas) Main subject: Esophageal and Gastric Varices / End Stage Liver Disease Type of study: Diagnostic study / Etiology study / Observational study / Prognostic study / Risk factors Limits: Humans Language: English Journal: Clinics Journal subject: Medicine Year: 2021 Type: Article Affiliation country: Brazil Institution/Affiliation country: UNICAMP)+BR