| Objective:Cirrhotic patients with acute esophagogastric variceal hemorrhage have a high mortality rate(15-20%)and a high rate of treatment failure(10-15%).Risk stratification facilitates adjustment of treatment strategies and improvement of prognosis.Our aim is to improve the risk prediction of patients with AVB,evaluate the clinical application value of different predictive models in recent years,identify independent risk factors,and evaluate the predictive efficacy of the self-built model.Methods:Retrospective investigation of cirrhotic patients with acute variceal bleeding(AVB)at the Third Central Hospital of Tianjin from January 1,2014 to December 31,2014.We recorded the general clinical data,endoscopic findings,and specific interventions,etc.The AIMS65 score?the Glasgow-Blatchford(GBS)score?the full Rockall score(FRS)score ? the End-Stage Liver Disease(MELD)? the MELD-Na model and the Child-Pugh score were calculated on the first day of admission.The final outcome during6-week of hospitalization was the endpoint in this study.The overall performance of these models were compared by discrimination and calibration with the software of SPSS20.0.Single-factor Logistic regression and multi-factor Logistic regression were used to predict the independent risk factors of death at 6 weeks in patients with AVB.We compared the prediction performance of the new Logistic scoring model and the updated MELD Logistic model and the MELD model.Results:1.Among the 202 patients,150 patients were male,accounting for 74.3% of the total,with an average age of(56.8 ± 11.8)years.We divided them into survival group(179 cases)and death group(23 cases,11.4%).2.The AIMS65 score(Z =-5.0,P <0.01),GBS score(Z =-3.5,P <0.01),FRS score(Z =-3.8,P <0.01),MELD score(Z=-4.1,P<0.01),MELD-Na score(t=4.7,P<0.01),CTP score(Z=-4.0,P<0.01)scores were statistically significant between survival group and death group.3.The AUC of AIMS65,GBS,FRS,MELD,MELD-Na and CTP scores were 0.808(95% CI: 0.719-0.896),0.726(95% CI: 0.628-0.823),0.738(95% CI: 0.628-),respectively.0.848),0.761(95% CI: 0.660-0.863),0.781(95% CI: 0.683-0.879)and0.748(95% CI: 0.650-0.847).Except the CTP score,the goodness-of-fit test results showed that the P values of AIMS65,GBS,FRS,MELD,and MELD-Na scores were more than 0.05.4.Univariate analysis showed that serum sodium,albumin,bilirubin,urea nitrogen,hemoglobin,INR,hepatic encephalopathy,systolic blood pressure,pulse,and hepatocellular carcinoma were significantly different in clinical laboratory parameters(P<0.05).Using multivariate Logistic regression analysis,the independent risk factors associated with 6-week mortality were hepatic encephalopathy(HE)(OR = 0.1,95%CI [0.031-0.408],P = 0.001),blood urea nitrogen(OR = 1.1,95% CI [1.027-1.245],P = 0.012),serum bilirubin(OR = 1.02,95% CI [1.002-1.03],P = 0.026)and pulse(OR = 1.05,95% CI [1.019-1.096 ],P = 0.003).5.The AUC of the MELD-PNa self-built model and the updated MELD model and the MELD model were 0.808(95% CI: 0.719-0.896),0.726(95% CI: 0.628-0.823)and 0.726(95% CI: 0.628-0.823)respectively;the P values of the goodness-of-fit test were respectively is 0.598,0.330 and 0.330.Conclusions:1.In this study,the 6-week mortality rate of AVB patients was 11.4%.2.In patients with AVB,compared with the death group,the AUC of AIMS65,MELD,and MELD-Na scores were more than 0.75.The discrimination of this three scores was good.The discrimination of GBS,FRS,and CTP scores was less than the others with the AUC of 0.6-0.75.The calibration of AIMS65,GBS,FRS,MELD,MELD-Na scores was good.The overall performance of AIMS65 and MELD-Na scores was better than the others.The independent risk factors for death of patients with AVB at 6 weeks were hepatic encephalopathy(HE),blood urea nitrogen,serum bilirubin,and pulse.4.The updated MELD model and the MELD model have the same degree of discrimination and calibration.The MELD-PNa self-built model has better discrimination and consistency than the updated MELD and MELD models. |
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