Predicting early rebleeding and mortality after endoscopic hemostasis of esophagogastric varices: Diagnostic performance of aspartate aminotransferase-to-platelet ratio index and model for end-stage liver disease-Na score.

IF 4.3 3区 材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC ACS Applied Electronic Materials Pub Date : 2024-07-18 DOI:10.1002/jhbp.12057
Shinya Yokoyama, Takashi Honda, Yoji Ishizu, Norihiro Imai, Takanori Ito, Kenta Yamamoto, Kazuyuki Mizuno, Masanao Nakamura, Hiroki Kawashima
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Abstract

Background: Endoscopic variceal ligation and sclerotherapy are recommended for esophagogastric variceal bleeding (EGVB) in cirrhosis but can be complicated by early rebleeding and death. This study aimed to identify noninvasive markers accurately predicting early rebleeding and mortality after endoscopic hemostasis for EGVB.

Methods: Among 116 patients with endoscopically confirmed EGVB and endoscopic hemostasis, various noninvasive markers were calculated, and their predictive accuracy was compared by receiver-operating characteristic curve analysis. Endpoints included 5-day rebleeding, 5-day mortality, 6-week rebleeding, and 6-week mortality.

Results: The median age was 63 years. Child-Pugh class B and C patients accounted for 40.5% and 34.5%, respectively. Only the aspartate aminotransferase-to-platelet ratio index (APRI) significantly predicted 5-day rebleeding, with an area under the curve (AUC) of 0.777 (95% confidence interval [CI]: 0.537-1). The model for end-stage liver disease-Na (MELD-Na) score showed good predictive accuracy for 5-day mortality (AUC: 0.839, 95% CI: 0.681-0.997), 6-week rebleeding (AUC: 0.797, 95% CI: 0.663-0.932), and 6-week mortality (AUC: 0.888, 95% CI: 0.797-0.979).

Conclusions: Patients with cirrhosis with a high APRI and MELD-Na score were at high risk of early rebleeding and death after EGVB. Allocating appropriate monitoring and care for those patients is necessary.

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预测食管胃静脉曲张内镜止血后的早期再出血和死亡率:天冬氨酸氨基转移酶与血小板比率指数和终末期肝病-Na评分模型的诊断性能。
背景:肝硬化食管胃底静脉曲张出血(EGVB)推荐采用内镜下静脉曲张结扎和硬化治疗,但可能会因早期再出血和死亡而变得复杂。本研究旨在确定能准确预测内镜下止血治疗 EGVB 后早期再出血和死亡率的无创标记物:方法:在116例经内镜确诊为EGVB并行内镜止血的患者中,计算了各种无创标记物,并通过接收器-操作特征曲线分析比较了它们的预测准确性。终点包括 5 天再出血、5 天死亡率、6 周再出血和 6 周死亡率:中位年龄为 63 岁。Child-Pugh分级B级和C级患者分别占40.5%和34.5%。只有天冬氨酸氨基转移酶与血小板比值指数(APRI)能显著预测5天再出血,其曲线下面积(AUC)为0.777(95% 置信区间[CI]:0.537-1)。终末期肝病-Na(MELD-Na)评分模型对5天死亡率(AUC:0.839,95% CI:0.681-0.997)、6周再出血(AUC:0.797,95% CI:0.663-0.932)和6周死亡率(AUC:0.888,95% CI:0.797-0.979)显示出良好的预测准确性:结论:APRI和MELD-Na评分较高的肝硬化患者在EGVB术后早期再出血和死亡的风险较高。有必要对这些患者进行适当的监测和护理。
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7.20
自引率
4.30%
发文量
567
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