Value of albumin-bilirubin score in predicting the prognosis of cirrhotic patients with esophagogastric variceal bleeding / 临床肝胆病杂志

ABSTRACT

ObjectiveTo investigate the value of albumin-bilirubin (ALBI) score in predicting the prognosis of cirrhotic patients with esophagogastric variceal bleeding, and to identify risk stratification and increase clinical applicability. MethodsA retrospective analysis was performed for the clinical data of 273 cirrhotic patients with esophagogastric variceal bleeding who were hospitalized in Subei People’s Hospital of Jiangsu from October 2012 to August 2018, and all patients received standard management after admission. Survival status was obtained through electronic medical records and telephone follow-up, and according to the prognosis in August 2020, the patients were divided into death group with 109 patients and survival group with 164 patients. General data were compared between the two groups. The Mann-Whitney U test was used for comparison of continuous variables between two groups, and the chi-square test or the Fisher’s exact test was used for comparison of categorical variables between two groups; univariate and multivariate Cox regression analyses were used to identify independent risk factors for prognosis. The Kaplan-Meier curve was used to analyze the survival rates of patients with different ALBI grades, and the log-rank test was used for comparison between groups; the receiver operating characteristic (ROC) curve was plotted to compare the ability of ALBI score, Child-Turcotte-Pugh (CTP) score, and Model for End-Stage Liver Disease (MELD) score in predicting short-term (6 weeks) and long-term prognoses. ResultsDuring follow-up, 109 patients (39.9%) died, and the death group had a significantly higher ALBI score than the survival group ［-1.49 (-1.82 to -1.11) vs -1.79 (-2.22 to -1.49), Z=5.630, P＜0.001］. The univariate analysis showed that age ≥55 years, hemoglobin ≤100 g/L, neutrophil count ≥3.4×109/L, platelet count ≤42×109/L, albumin ≤28 g/L, total bilirubin ≥21 μmol/L, alanine aminotransferase ≥42 U/L or aspartate aminotransferase ≥48 U/L, creatinine ≥94 μmol/L, serum sodium ≤137 mmol/L, international normalized ratio of prothrombin ≥1.5, ascites, and hepatic encephalopathy were risk factors for death in cirrhotic patients with esophagogastric variceal bleeding, and the patients with ALBI grade 3 had a significantly higher risk of death than those with ALBI grade 1 or 2; prophylactic ligation was a protective factor for survival improvement in cirrhotic patients with esophagogastric variceal bleeding (all P＜0.05). The multivariate analysis showed that age ≥55 years (hazard ratio ［HR］=2.531, 95% confidence interval ［CI］ 1.624-3.946, P＜0.001), creatinine ≥94 μmol/L (HR=1.935, 95% CI 1.208-3.100, P=0.006), serum sodium ≤137 mmol/L ［HR=1.519, 95% CI 1.015-2.274, P=0.042］, ascites (HR=1.641, 95% CI 1.041-2.585, P=0.033), hepatic encephalopathy (HR=9.972, 95% CI 3.961-25.106, P＜0.001), and ALBI grade 3 (HR=1591, 95% CI 1.007-2.515, P=0.047) were independent risk factors for death. The patients with ALBI grade 3 had a significantly lower survival rate than those with ALBI grade 1 (χ2=18.691, P＜0.001) and ALBI grade 2 (χ2=21.364, P＜0.001), and the patients with ALBI grade 1 had a significantly higher survival rate than those with ALBI grade 2 (χ2=6513, P=0.011). The ROC curve analysis showed that ALBI score, CTP score, and MELD score had an area under the ROC curve (AUC) of 0770, 0.730, and 0.706, respectively, in predicting short-term (6 weeks) prognosis, and they had an AUC of 0.701, 0685, and 0659, respectively, in predicting long-term prognosis. ConclusionALBI score has a good value in predicting short-term (6 weeks) and long-term prognoses of cirrhotic patients with esophagogastric variceal bleeding, and the risk of death increases with ALBI grade. ALBI score can be used as an objective and simple model in clinical practice.