Erschienen in:
04.03.2019 | Original Article
Development and Validation of a Novel Model for Outcomes in Patients with Cirrhosis and Acute Variceal Bleeding
verfasst von:
Gyanranjan Rout, Sanchit Sharma, Deepak Gunjan, Saurabh Kedia, Anoop Saraya, Baibaswata Nayak, Vishwajeet Singh, Ramesh Kumar, Shalimar
Erschienen in:
Digestive Diseases and Sciences
|
Ausgabe 8/2019
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Abstract
Background
Acute variceal bleeding (AVB) in patients with cirrhosis is associated with high mortality, ranging from 12 to 20% at 6 weeks. The existing prognostic models for AVB lack precision and require further validation.
Aim
In this prospective study, we aimed to develop and validate a new prognostic model for AVB, and compared it with the existing models.
Methods
We included 285 patients from March 2017 to November 2017 in the derivation cohort and 238 patients from December 2017 to June 2018 in the validation cohort. Two prognostic models were developed from derivation cohort by logistic regression analysis. Discrimination was assessed using area under the receiver operator characteristic curve (AUROC).
Results
The 6-week mortality was 22.1% in derivation cohort and 22.3% in validation cohort, P = 0.866. Model for end-stage liver disease (MELD) [odds ratio (OR) 1.106] and encephalopathy (E) (OR 4.658) in one analysis and Child–Pugh score (OR 1.379) and serum creatinine (OR 1.474) in another analysis were significantly associated with 6-week mortality. MELD-E model (AUROC 0.792) was superior to Child-creatinine model (AUROC) in terms of discrimination. The MELD-E model had highest AUROC; as compared to other models—MELD score (AUROC 0.751, P = 0.036), Child–Pugh score (AUROC 0.737, P = 0.037), D’Amico model (AUROC 0.716, P = 0.014) and Augustin model (AUROC 0.739, P = 0.018) in derivation cohort. In validation cohort, the discriminatory performance of MELD-E model (AUROC 0.805) was higher as compared to other models including MELD score (AUROC 0.771, P = 0.048), Child–Pugh score (AUROC 0.746, P = 0.011), Augustin model (AUROC 0.753, P = 0.039) and D’Amico model (AUROC 0.736, P = 0.021).
Conclusion
In cirrhotic patients with AVB, the novel MELD-Encephalopathy model predicts 6 weeks mortality with higher accuracy than the existing prognostic models.