| Objective: To evaluate clinical value of Child –Pugh,model of end-stage liver disease(MELD),the MELD-Na model and AIMS65 in predicting the rebleeding and death of patients with decompensated cirrhosis who recieved endoscopic treatment of esophageal-gastric variceal bleeding(EVB);to compare the capacity of CTP,MELD,MELD-Na and AIMS65 in predicting the rebleeding and death in patients.Methods: 1.A total of 216 patients who were diagnosed as cirrhosis with EVB from January 2009 to January 2018 and treated with endoscopy for the first time according to the Chronic Hepatitis B Prevention and Treatment Program revised by Xi’an Conference in 2010 were collected.2.Patients with severe heart,lung and kidney diseases;or malignant tumors;or liver transplant patients;or patients who have undergone endoscopic treatment,transjugular intrahepatic portosystemic shunt and surgical treatment were excluded.Patients with incomplete data and follow-up results were also excluded.3.All patients enrolled in the study were scored using four scoring models: CTP,MELD,MELD-Na,and AIMS65.The rebleeding rate and death within 3month and 6 month after endoscopic treatment were recorded.Receiver operating characteristic curve(ROC)and area under the curve(AUC)were used to evaluate the predictive value of four scoring models for patients with rebleeding and death.Results:1.The time point after endoscopic treatment was used as the starting point,while the end point was described as 6 months after endoscopic treatment.During the follow-up period,75 patients(34.7%)had rebleeding,including 43 patients(19.9%)with rebleeding in 3 months,accounting for 57.3% of patients with total rebleeding.Thirty-one patients(14.4%)died during the follow-up,including 20 patients in 3 months(9.3 %),accounting for 64.5% of the total deaths.Multivariate regression analysis showed that three indicators,age greater than 65 years,hepatic encephalopathy,and serum sodium less than 135 mmol/L were independent risk factors for rebleeding and death after endoscopic treatment in patients with decompensated cirrhosis.2.The CTP score,MELD score,MELD-Na score and AIMS65 score of patients in the3 month and 6 month rebleeding group were significantly higher than those without bleeding,respectively(P < 0.001).3.The CTP score,MELD score,MELD-Na score and AIMS65 score in 3 month and 6month death group were significantly higher than their survival counterparts,respectively(P < 0.001).4.In line with the increase of CTP,MELD,MELD-Na and AIMS65 scores,the rebleeding rate and mortality of patients in 3month and 6month showed corresponding increase(P< 0.01).5.Based on the area under the curve for patients within 3 month and 6 month rebleeding group,the predictive ability of AIMS65 scoring model is larger than CTP,MELD,MELD-Na scoring model.There were statistically significance in the score value in AIMS65,MELD,and MELD-Na compared to CTP(P<0.01).AUC are 0.876,0.774,0.827,0.867,and 0.891,0.795,0.871,0.888,respectively.6.Based on the area under the curve of scoring model for patients with 3mo and 6mo mortality,prediction ability of MELD-Na was larger than CTP,MELD,and AIMS65 scoring models;AUC were 0.915,0.874,0.848,0.884,and 0.918,0.895,0.875,0.868,respectively(P>0.05).Conclusion:1.Age more than 65 year-old,HE and serum sodium of less than 135mmol/L are independent risk factors for rebleeding and death after endoscopic treatment in patients with decompensated cirrhosis.2.CTP,MELD,MELD-Na and AIMS65 can effectively evaluate the severity of patients with decompensated cirrhosis after EVB endoscopic treatment,and have good predictive value for patients with rebleeding and prognosis.3.The AIMS65 score is superior to the CTP score in predicting the rebleeding.4.There are no significant difference among the CTP、MELD、MELD-Na and AIMS65 scores in predicting the death.However,the AIMS65 scoring model is simple and easy to operate at work,which opens new avenue in the clinical application. |
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