| Background Liver cirrhosis with esophageal and gastric variceal bleeding(EGVB)is a common emergency and severe disease,and one of the main causes of upper gastrointestinal bleeding(UGIB),correct assessment of the patient’s condition is helpful to guide clinical treatment.GBS and AIMS65 are pre-endoscopic risk assessment tool for patients presenting with unselected UGIB,MELD is a universal model of liver cirrhosis in the world at present.However there are few data on their use in patients with variceal bleeding,who are generally accepted as being at high risk of poor outcome,the evaluation value and risk factors for poor prognosis need further study.Objective 1.To evaluate the ability of MELD,GBS and AIMS65 scoring systems to correctly classify cirrhosis patients with EGVB as "high risk patients",and the predictive value of different clinical outcomes.2.The main risk factors for death of cirrhosis patients with EGVB were analyzed to provide reference for further development of the scoring system for cirrhosis patients with EGVB.Method 1.182 cases of cirrhosis with EGVB admitted to Tianjin Medical University General Hospital on January 1,2015--March 1,2018 were retrospectively analyzed.The MELD,GBS and AIMS65 scores were calculated for each patient.Patients were divided into groups according to different clinical outcomes,and the AUC and cut-off values of the three scores on blood transfusion,rebleeding,and death were calculated respectively to assess the predictive value.2、Univariate analysis and binary Logistic regression analysis were used to determine the main risk factors for death of cirrhosis with EGVB patients.Results 1.Viral hepatitis,autoimmune liver disease and alcoholic liver disease are the top three causes of cirrhosis,accounting for 44.5%,17% and 9.9% respectively.There were 89 males and 93 females,and the ratio of male to female was nearly 1:1,the average age was 59.7±11.9 years;The average hospitalization time was 13.9±5.8 days.During the period of hospitalization,113 patients received blood transfusion,31 rebleeding,and 11 died.2.Among 182 cirrhotic patients with EGVB,there were no GBS < 3 patients,but there were 68 patients with AIMS 65 =0,71 patients with AIMS score =1,and 4 patients with MELD < 9.3.GBS and AIMS65 scores of blood transfusion patients were higher than those of non-transfusion patients(P <0.05).There was no statistically significant difference between the three scores of patients with and without rebleeding(P >0.05).AIMS65 score of the dead was higher than that of the survived(P <0.05).4.When predicting blood transfusion,the AUC of MELD,GBS and AIMS65 scoring system were 0.514,0.681,0.669,and the optimal diagnostic threshold were > 15,>11,>0 respectively,GBS and AIMS65 were better than MELD(P <0.05);When predicting rebleeding,the AUC of MELD,GBS and AIMS65 scoring system was 0.525,0.528 and 0.580,and the optimal diagnostic threshold were > 17,>11,>0 respectively,with low predictive value and no statistically significant difference(P >0.05);When predicting death,the AUC of MELD,GBS and AIMS65 were 0.642,0.581 and 0.786,and the optimal diagnostic threshold were >15、>13,>1 respectively,AIMS65 has a higher predictive value for death.5.Hemoglobin,PT-INR,albumin and total bilirubin were associated with death,Among them,PT-INR were the independent risk factor.Conclusion 1.Viral hepatitis is still the main cause of liver cirrhosis,but the incidence has gradually declined,in recent years,the cause of liver cirrhosis changes significantly.2.GBS can correctly classify cirrhosis patients with EGVB as a "high-risk patients",it is helpful for patients to get timely and correct diagnosis and treatment,better than AIMS65 and MELD;AIMS65 has a higher predictive value for death;MELD,GBS and AIMS65 have poor accuracy in predicting blood transfusion and rebleeding.3.PT-INR is an independent risk factor for death in cirrhosis patients with EGVB. |
PDF Full Text Request