D Dimer To Albumin Ratio To Assess The Risk Of Variceal Rupture Bleeding In Patients With Liver Cirrhosis And Esophagofundus Variceal Veins

Background:esophagogastric variceal hemorrhage(EGVB)is a serious complication of esophagogastric variceal hemorrhage caused by Portal hypertension(PHT).Cirrhosis caused by various etiology is the main cause of portal hypertension.Cirrhosis is a progressive disease that impairs liver function and reduces life expectancy [1].The development of Gastroesophageal varices(GEVs)is a hallmark of the natural history of cirrhosis.GEVs represent the clinical manifestations of portal hypertension and increase the risk of decompensation.Acute variceal bleeding(AVB)is caused by varicose rupture and can significantly affect prognosis and increase the risk of death.Although the prognosis of EGVB has improved significantly over the past few decades due to better management of the hemorrhage itself and its associated complications,the mortality rate is still as high as 15-20%[2].It is also important to note that patients who survive an episode of varicose bleeding are at high risk of rebleeding,and the mortality rate from rebleeding is as high as that from the first hemorrhage.Therefore,it is important to assess the risk of death bleeding and stratify the management of patients to provide more efficient,individualized,and prospective treatment.Hepatic vein pressure gradient(HVPG)and endoscopic examination can directly reflect the changes of portal vein pressure and varicose veins in the esophagogastric fundus,which is helpful to evaluate the risk of bleeding.However,all the above measures are invasive and expensive.However,stratified risk scoring systems such as Meld score,Child score and Rockall score require input of various variables and are complex in application,which is limited in early onset and when clinical symptoms are not obvious.There is therefore a need to explore noninvasive,inexpensive,and convenient preventive screening and testing methods to assess the risk of cirrhosis and esophagogastric variceal bleeding.The application value of D-dimer to albumin ratio(DAR)in predicting the prognosis of post-HBV decompensation in cirrhosis,gastric cancer,COVID-19 and other diseases has been reported.However,the clinical value of DAR in predicting EGVB remains unclear.Purpose:To analyze the clinical application value of DAR in predicting varicose hemorrhage in patients with cirrhosis and esophagogastric varicose.Method:A total of 211 hospitalized patients diagnosed with cirrhosis and esophagogastric varices in Huaihe Hospital of Henan University from January 2019 to December 2022 were selected as the research objects.They were divided into hemorrhage group and non-hemorrhage group according to whether EGVB was present or not.The clinical data of the two groups were analyzed by univariate analysis.Multivariate logistic regression analysis was performed for variables with statistically significant differences(p < 0.05)and cutoff values determined by Youden Index of receiver operating characteristics(ROC)curve to determine independent influencing factors.Area under ROC curve(AUC)was used to evaluate the diagnostic effectiveness of DAR in predicting bleeding events.Results:Among 211 patients with cirrhosis and esophagogastric varices,173 were in the bleeding group and 38 were in the non-bleeding group.Univariate analysis showed that there were statistically significant differences in DAR,d dimer,serum albumin,INR,PT,blood urea nitrogen,Rockall score,Meld score and Child score between the two groups(P < 0.05).The area under ROC curve of DAR was0.714(sensitivity 0.647,specificity 0.763),and the 95% confidence interval(CI)was 0.617-0.812.The DAR cutoff value based on the Yoden index was 40.54.Multivariate logistic regression analysis showed that DAR>40.54 and Rockall scores were significantly different between the two groups.DAR>40.54(OR:3.861,[95%CI:1.108--13.455],P=0.034)was an independent risk factor for bleeding events,and DAR was significantly higher in the bleeding group than in the non-bleeding group.Patients were grouped according to the DAR truncation value.The proportion of gastrointestinal bleeding in the high DAR group was 92.6%(112/121),while that in the low DAR group was 67.8%(61/90),with significant difference between the two groups(P < 0.05).The high DAR group had lower albumin,higher D dimer,higher Meld score,higher Child score,higher Rockall score,higher AST,higher TBIL,higher INR,higher PT(P < 0.05),suggesting that DAR has the value of disease stratification.Conclusion:1.DAR calculation is simple,which may be an indicator for early clinical assessment of bleeding risk in patients with cirrhosis accompanied by esophagogastric varices,and has good diagnostic value.2.DAR>40.54 was independently associated with bleeding events.3.DAR has good diagnostic value for disease stratification and prognosis.