| Objective:This study retrospectively analyzed the clinical characteristics of patients with liver cirrhosis and esophageal gastric variceal bleeding(EGVB)in our hospital,and compared AIMS65,GBS,MGBS,EGBS,CRS,CANUKA,Child-Turcotte-Pugh(CTP),The MELD and MELD-Na scoring systems have the ability to identify patients with rebleeding,need for blood transfusion,and death,and determine reasonable thresholds,so as to facilitate early identification of high-risk patients in clinical work,and early intervention to improve patient recovery.Methods:Collect patients diagnosed with liver cirrhosis and EDVB from the Second Affiliated Hospital of Kunming Medical University from January 2018 to June 2019,screen out eligible patients(169 cases in total),and record the general patient information(name,gender,age,etc.)in detail)And vital signs,laboratory indicators,etiology of liver cirrhosis,whether and what method of clinical intervention and treatment,disease outcome,etc.,analyze its general characteristics based on the above data.According to AIMS65,GBS,MGBS,EGBS,CRS,CANUKA,Child-Turcotte-Pugh(CTP),MELD,and MELD-Na scoring standards,patients with liver cirrhosis and EDVB after admission to the hospital will be scored with vital signs and first laboratory indicators,Evaluate the predictive ability of the above nine kinds of scores for patients with different clinical outcomes(rebleeding,need blood transfusion,and death),and draw the receiver operating characteristic curve(ROC)of each score based on the above three clinical outcomes.),the area under ROC curve(AUROC)of each score is used to judge the predictive ability of the above-mentioned scoring system for different clinical outcomes,and each score is calculated to identify high-risk patients with the above three clinical outcomes The best critical value.Logistic regression analysis was used to screen out the risk factors for in-hospital rebleeding or death in patients with liver cirrhosis and EDVB.Results:1.A total of 169 cases of patients with liver cirrhosis and EGVB were collected,of which 111 received in-hospital blood transfusion,35 were bleeding again during hospitalization,and 8 died.2.Patients’ general information,clinical manifestations,comorbidities and main test indicators:The average age of these patients was 55.0±12.6 years(range 20 to 81 years),of which 108 were male patients(63.9%)and 61 were female patients(36.1%).Clinical manifestations:155 patients(91.7%)with a history of melena,15 patients(8.9%)with varying degrees of change in consciousness,and 8 patients(4.8%)with syncope due to massive blood loss.Major concomitant diseases:24 cases of diabetes,8 cases of central system disease(5 cases of cerebral infarction,2 cases of cerebral hemorrhage,1 case of pituitary tumor),14 cases of heart disease(13 cases of heart failure,1 case of coronary stent implantation)Cases),31 cases of malignant tumors,3 cases of liver failure,2 cases of renal failure,and 1 case of pulmonary embolism during hospitalization.Main examination and test results:135 patients had ascites,of which 58 patients had moderate or above ascites.White blood cells 4.82(3.2-7.5)×10^9/L,hemoglobin 84.0(68.0-100.5)g/L,platelets 80(45-116)×10^9/L,ALT 36(27-51)U/L,AST 43(27.0-65.5)U/L,plasma albumin 28.8(25.5-32.9)g/L,total bilirubin 26.4(16.6-37.9)μmol/L,creatinine 66(54-82)μmol/L,urea Nitrogen 7.0(5.0-10.4)mmol/L,serum sodium ion concentration 138.0(136.2-140.2)mmol/L,prothrombin time measured 16.7(15.2-18.4)s,INR 1.4(1.2-1.5).The median length of hospital stay was 13(9-16.5)days.3.In this study,hepatitis is still the main cause of liver cirrhosis(52.7%).Compared with previous studies,the proportion of the same type of study shows a downward trend.4.The AIMS65,GBS,MGBS,EGBS,CRS,CANUKA,CTP,MELD,and MELD-Na scores of patients with liver cirrhosis and EDVB treated by blood transfusion are generally higher than those of patients without blood transfusion,but there is no difference in CRS scores between the two Statistically significant(P=0.186),and the differences between the other scores were statistically significant(P<0.05).After the ROC curve analysis of all scoring systems,the results show that the AIMS65 score is the best in predicting patient blood transfusion,and its AUROC(95%CI)is 0.755(0.683-0.818).The AUROC value of the remaining scores and the AIMS65 score are subjected to Z test Later,it was found that only the AUROC differences between MELD,MELD-Na,CRS scores and AIMS65 scores were statistically significant(P<0.05).The best cut-off values of AIMS65,CTP,EGBS,GBS,MGBS,CANUKA,MELD-Na,MELD,and CRS for predicting blood transfusion are>1,＞7,＞10,＞11,＞8,＞8,＞11,＞10、＞2.5.The scores of AIMS65,GBS,MGBS,EGBS,CRS,CANUKA,CTP,MELD,and MELD-Na in patients with liver cirrhosis EDVB who have rebleeding in the hospital are generally higher than those of patients without rebleeding in the hospital.The scores between the two groups of patients The differences were statistically significant(P<0.05).After the ROC curve analysis of all scoring systems,the results show that the AIMS65 score is the best in predicting rebleeding in the hospital.Its AUROC(95%CI)is 0.728(0.654-0.793).The AUROC value of the remaining scores is compared with the AIMS65 score.After the Z test,it was found that there was no statistically significant difference between the AIMS65 score and other scores(P＞0.05).The best cut-off values of AIMS65,CTP,MELD-Na,MELD,EGBS,GBS,CANUKA,CRS,MGBS for predicting in-hospital rebleeding are＞ 1,＞ 7,＞10,＞10,＞11,＞10,＞ 8.＞2,＞5.6.The scores of AIMS65,GBS,EGBS,CRS,CANUKA,CTP,MELD,and MELD-Na in patients with liver cirrhosis who died in the hospital were generally higher than those of patients without hospital death,and the MGBS score in the hospital death group was lower than the survival group,Only CTP,AIMS65,CANUKA,MELD-Na score difference between the two groups were statistically significant(P<0.05),and the other scores between the two groups were not statistically significant(P＞0.05).After the ROC curve analysis of all scoring systems,the results show that the CTP score is the best in predicting the death of a patient in the hospital.Its AUROC(95%CI)is 0.887(0.830-0.931).The AUROC value and CTP score of the remaining scores are calculated as Z After the test,it was found that the AUROC difference between the CTP score and the CANUKA score was not statistically significant(P>0,05),and the AUROC difference between the other scores and the CTP score was statistically significant(P>0.05).The best cut-off values of CTP,AIMS65,MELD-Na,CANUKA,CRS,MELD,EGBS,GBS,and MGBS for predicting in-hospital death are>10,>2,>13,>10,>2,>13,>9,>8,>5.7.A univariate statistical analysis of 18 objective indicators showed that Hb,ALB,PT,and INR were related to the poor outcome of patients with liver cirrhosis and EDVB(P<0.05).After they were further included in the binary logistic regression analysis,it was found that only ALB It is an independent risk factor for poor recovery of patients with liver cirrhosis and EDVB.Conclusion:1.In this study,hepatitis B is still the main cause of liver cirrhosis,but compared with previous studies,the proportion of hepatitis B cirrhosis shows a downward trend.2.AIMS6565 score can better predict blood transfusion and rebleeding in hospital after admission of patients with liver cirrhosis and EDVB.CTP and AIMS65 scores are excellent in predicting hospital death.3.ALB is an independent protective factor for poor recovery in patients with liver cirrhosis and EGVB. |
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