| Objective:The independent risk factors of rebleeding and death within 1 year after endoscopic treatment of liver cirrhosis patients with EGVB were retrospectively analyzed.To verify the predictive value of ALBI score for rebleeding and death within1 year after endoscopic treatment of EGVB patients with cirrhosis,and compare it with CTP score,MELD score and MELD-Na score.Methods:A total of 338 patients with EGVB in liver cirrhosis who underwent endoscopic treatment for the first time in the Department of Gastroenterology,First Affiliated Hospital of Nanchang University from January 1,2016 to March 1,2020were selected.Complete follow-up to obtain the prognosis of patients through follow-up,reviewing medical record information and making phone calls.Taking rebleeding as the primary endpoint of the study and death as the secondary endpoint,according to the prognosis of follow-up to March 2021,patients were divided into rebleeding group and No rebleeding group,death group and survival group.The independent risk factors of rebleeding and death were analyzed,and the predictive power of ALBI score for rebleeding and death was verified by ROC curve,and compared with CTP score,MELD score and MELD-Na score.Results:1.A total of 338 EGVB patients with liver cirrhosis were included in this study,including 257 male patients,accounting for 76%,with an average age of 52.6±11.8,the oldest age of 79 years,and the youngest age of 20 years.Among them,209 patients had hepatitis B due to cirrhosis.(61.8%).130 EGVB patients with cirrhosis developed rebleeding within 1 year after endoscopic surgery,with a rebleeding rate of 38.5%,and66 patients died within 1 year after surgery,with a mortality rate of 19.5%.2.Comparison of basic clinical data between the rebleeding group and the non-bleeding group,gender,age,length of hospital stay,concomitant diseases,etiology of liver cirrhosis,previous EGVB,concurrent hepatic encephalopathy,bacterial infection,oral administration of NSBB,and follow-up endoscopy There was no significant difference in treatment(P>0.05);22 cases(16.9%)with moderate ascites and 18 cases(13.9%)with severe ascites in the rebleeding group were significantly higher than those in the non-bleeding group(15 cases(7.2%)and 6 cases(2.9%)),the difference was statistically significant(P<0.001);27 cases(20.8%)of portal vein thrombosis in the rebleeding group were higher than 23 cases(11.1%)in the non-bleeding group,and the difference was statistically significant(P=0.014).Comparing the basic clinical data between the death group and the survival group,gender,age,length of hospital stay,concomitant disease,etiology of liver cirrhosis,previous EGVB,hepatic encephalopathy,bacterial infection,oral NSBB,and follow-up endoscopic treatment were all compared between the two groups.There was no significant difference(P>0.05);the proportion of moderate ascites in the death group was 16.7%higher than that in the survival group(9.6%),and the severe ascites in 16 cases(24.3%)in the death group was significantly higher than that in the survival group in 8 cases(2.9%).Significant(P<0.001);the proportion of portal vein thrombosis in the death group was24.2%higher than that in the survival group(12.5%),and the difference was statistically significant(P=0.016).3.There was no significant difference in WBC,PLT,NEU,TLC,ALT,Cr,BUN,Na~+and K~+between the rebleeding group and the non-bleeding group(P>0.05);the median Alb in the rebleeding group 28.7 was significantly lower than the non-bleeding group 33.4(P<0.001),the median TBil was 25.3 higher than the non-bleeding group18.2(P<0.001),and the median INR was 1.37 higher than the non-bleeding group1.23(P<0.001).In addition,there were significant differences in RBC,Hb,AST,TC,PT and Fib between the two groups(P<0.05).There was no significant difference in PLT,TLC,ALT,TC,Cr,BUN and K~+between the death group and the survival group(P>0.05).The median Alb in the death group was 27.6,which was significantly lower than that in the survival group,which was 32.3(P<0.001),the median TBil was28.9 higher than the survival group 19.1(P<0.001),and the median INR was 1.38higher than the survival group 1.26(P<0.001).In addition,there were significant differences in RBC,Hb,WBC,NEU,AST,Na~+,PT and Fib between the two groups(P<0.05).4.Comparison of endoscopic characteristics between the rebleeding group and the non-bleeding group,emergency endoscopy,endoscopic location of varicose veins,varices type,varices diameter,Rf,endoscopic treatment method,whether there is erosion under endoscopy,There was no significant difference in thrombosis,ulcer and portal hypertensive gastropathy;however,36 cases(27.7%)of active bleeding under endoscopic rebleeding group were higher than 32 cases(15.4%)of non-bleeding group,and the difference was statistically significant(P=0.006).Comparison of endoscopic characteristics between the death group and the survival group,emergency endoscopy,endoscopic location of varices,varices type,varices diameter,Rf,endoscopic treatment,endoscopic erosion,thrombosis,There was no significant difference in ulcer and portal hypertensive gastropathy;however,the proportion of active bleeding under endoscopy in the death group was 33.3%higher than that in the survival group(16.9%),and the difference was statistically significant(P=0.003).5.There was a significant difference in ALBI score between the rebleeding group and the non-bleeding group(P<0.001).47 patients with ALBI score 3 in the group were significantly higher than 21 patients in the non-bleeding group(P<0.001).There was no significant difference in rebleeding rate with grade 2(P>0.05);the median CTP score in the rebleeding group was 8 higher than that in the non-bleeding group(P<0.001),and the CTP score in the rebleeding group in 22 cases was significantly higher than that in grade C.There were 6 cases in the non-bleeding group(P<0.001);the median MELD score and MELD-Na score in the rebleeding group were 12 higher than those in the non-bleeding group with MELD score of 9 and MELD-Na score of 9(P<0.001).Compared with the survival group,there was a significant difference in ALBI score between the two groups(P<0.001).The mean ALBI score in the death group(-1.31±0.51)was significantly higher than that in the survival group(-1.88±0.49).The ALBI score in the death group was grade 3.37 cases were significantly higher than the 31 cases in the survival group(P<0.001);pairwise comparison found that the mortality rate of patients with ALBI score 3 was significantly higher than that of grades1 and 2(P<0.05),and there was no difference in mortality between grades 1 and 2.Statistical significance(P>0.05);the median CTP score in the death group was 9 higher than that in the survival group 7(P<0.001),and the proportion of CTP score C in the death group was 21.2%higher than that in the survival group 5.1%(P<0.001);The median MELD score of 12 and the median MELD-Na score of 13 in the death group were higher than those in the survival group with MELD score of 9 and MELD-Na score of 9(P<0.001).6.ALBI score(HR:3.461),INR(HR:1.294),severe ascites(HR:3.010)and portal vein thrombosis(HR:2.261)were independent risk factors for rebleeding within1 year after endoscopic surgery in cirrhotic patients with EGVB.7.ALBI score(HR:6.991),Na~+(HR:0.919),severe ascites(4.151)and portal vein thrombosis(HR:1.813)were independent risk factors for death within 1 year after endoscopic surgery in patients with cirrhosis EGVB.8.The median bleeding-free time for all patients was 8.8 months(95%CI:8.3-9.3).The median time without bleeding was 11.4 months(95%CI:10.6-12.3)in patients with ALBI grade 1,9.3 months(95%CI:8.8-9.9)in patients with ALBI grade2,and 9.3 months(95%CI:8.8-9.9)in patients with ALBI grade 3.The time to bleeding was 5.5 months(95%CI:4.5-6.6).The cumulative rebleeding rate of all patients was 38.5%(130 cases),and the 1-year cumulative rebleeding rate of ALBI grade 3 patients was 69.1%,which was significantly higher than that of grade 1 patients,13.3%(χ2=30.034,P<0.001)and 32.9%of grade 2 patients(χ2=45.143,P<0.001).The median survival time of all patients was 10.6 months(95%CI:10.2-10.9),the median survival time of ALBI1 patients was 11.6 months(95%CI:10.9-12.3),and the median survival time of ALBI2 patients was 11.3 months(95%CI:11.0-11.5),and the median survival time for patients with ALBI grade 3 was 7.5 months(95%CI:6.4-8.7).The cumulative mortality of all patients was 19.5%.The 1-year cumulative mortality rate of ALBI grade 3 patients was 54.4%,which was significantly higher than that of grade 1 patients,3.3%(χ2=21.333,P<0.001)and 11.7%of grade 2 patients(χ2=81.833,P<0.001).9.There was a significant positive correlation between ALBI score and CTP score,MELD score and MELD-Na score(r values were 0.781,0.513,0.466,P<0.001).10.The ROC curve was used to evaluate the predictive value of the four scores for rebleeding within 1 year after endoscopic surgery.The AUCs of ALBI score,CTP score,MELD score and MELD-Na score were 0.765,0.752,0.743,and 0.733,respectively.The AUC of ALBI score was the largest,followed by CTP score,and MELD-Na was the smallest.Comparing the AUCs of the scores for judging the rebleeding rate within 1 year,there was no significant difference in the predictive power of the four scores(all P>0.05);The ROC curve was used to evaluate the predictive value of the four scores on the death of patients within 1 year after endoscopic surgery.the AUCs of the ALBI score,CTP score,MELD score and MELD-Na score were respectively 0.780,0.774,0.741,0.751,among which ALBI score AUC was the largest,followed by CTP score,and MELD score was the smallest.Comparing the AUC of each score in judging the mortality of patients within 1 year,there was no significant difference in the predictive power of the four scores(all P>0.05).Conclusion:1.The rebleeding rate of EGVB patients with cirrhosis within 1 year after endoscopic treatment was 38.5%,and the mortality rate was 19.5%.2.ALBI score,INR,severe ascites,and portal vein thrombosis are independent risk factors for rebleeding within 1 year after endoscopic treatment of cirrhosis patients with EGVB.3.ALBI score,Na~+,severe ascites,and portal vein thrombosis are independent risk factors for death within 1 year after endoscopic treatment of cirrhosis patients with EGVB.4.The ALBI score has a certain predictive value for rebleeding and death within1 year after endoscopic treatment of EGVB patients with cirrhosis.Compared with the CTP score,MELD score and MELD-Na score,the prediction performance for rebleeding and death is comparable.But the ALBI score is simpler and more objective,easy to obtain,and easy to use. |
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