Risk assessment of cirrhosis patients with esophageal and gastric variceal bleeding by three scoring systems

Abstract

Objective To compare the risk assessment capability of model for end-stage liver disease (MELD), glasgow-blatchford score (GBS), and the AIMS65 scoring system for liver cirrhosis patients with esophageal and gastric variceal bleeding (EGVB). Methods A retrospective analysis was made on data of 182 cirrhosis patients with EGVB admitted to the Department of Gastroenterology, General Hospital of Tianjin Medical University from January 1, 2015 to March 1, 2018. According to the MELD, GBS and AIMS65 scoring system, the corresponding scores of each patient were calculated to evaluate the ability of the three scoring systems to correctly classify EGVB as a " high-risk patient" . The receiver operating characteristic curve was drawn to compare the predictive value of three scoring systems for different clinical outcomes (blood transfusion, rebleeding, and death). The area under curve (AUC)>0.7 was believed to have higher accuracy. Results The clinical outcomes of 182 patients included blood transfusion in 113 (62.1%) cases, rebleeding in 31 (17.0%) cases, and death of 11 (6.0%) cases. The MELD score was 7-25, GBS was 3-16, and AIMS65 score was 0-3. There were 4 (2.2%) patients with MELD score < 9, 139 (76.4%) patients with AIMS65 score 0-1, including 68 patients with AIMS65 score of 0 and 71 patients with AIMS65 score of 1. The AUC of MELD, GBS and AIMS65 for predicting blood transfusion was 0.514 (95%CI: 0.439-0.589), 0.681 (95%CI: 0.608-0.748), and 0.669 (95%CI: 0.596-0.737), respectively. When predicting rebleeding, the AUC of MELD, GBS and AIMS65 was 0.525 (95%CI: 0.449-0.599), 0.528 (95%CI: 0.453-0.602) and 0.580 (95%CI: 0.505-0.652), respectively. When predicting in-hospital mortality, the AUC of MELD, GBS and AIMS65 was 0.642 (95%CI: 0.567-0.711), 0.581 (95%CI: 0.505-0.653) and 0.786 (95%CI: 0.719-0.843), respectively. AIMS65 was superior to MELD (P=0.083 6) and GBS (P=0.047 0). Conclusion GBS can correctly classify cirrhosis patients with EGVB as " high-risk group" , and is better than AIMS65 and MELD scoring system. MELD, GBS and AIMS65 all have poor accuracy in predicting blood transfusion and rebleeding, AIMS65 has a higher predictive value for death. Key words: Prognosis; Liver cirrhosis; Esophageal and gastric variceal bleeding; Scoring system