Risk stratification in acute variceal bleeding: Far from an ideal score.

Autor:	Aluizio CLS; Divisao de Gastroenterologia, Departamento de Clinica Medica, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (FCM/UNICAMP), Campinas, SP, BR., Montes CG; Divisao de Gastroenterologia, Departamento de Clinica Medica, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (FCM/UNICAMP), Campinas, SP, BR., Reis GFSR; Divisao de Gastroenterologia, Departamento de Clinica Medica, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (FCM/UNICAMP), Campinas, SP, BR., Nagasako CK; Divisao de Gastroenterologia, Departamento de Clinica Medica, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (FCM/UNICAMP), Campinas, SP, BR.
Jazyk:	angličtina
Zdroj:	Clinics (Sao Paulo, Brazil) [Clinics (Sao Paulo)] 2021 Jun 28; Vol. 76, pp. e2921. Date of Electronic Publication: 2021 Jun 28 (Print Publication: 2021).
DOI:	10.6061/clinics/2021/e2921
Abstrakt:	Objectives: Acute variceal bleeding (AVB) results from rupture of esophageal or gastric varices. It is a life-threatening complication of portal hypertension. Nevertheless, it remains unclear how to predict adverse outcomes and identify high-risk patients. In variceal hemorrhage, high Child-Turcotte-Pugh (Child) and Model for End-stage Liver Disease (MELD) scores are associated with a worse prognosis. The Rockall system (Rockall), Glasgow-Blatchford (Blatchford), and AIMS65 scores have been validated for risk stratification for nonvariceal upper gastrointestinal bleeding; however, their use is controversial in AVB. The aim of this study was to compare the performance of Child, MELD, Rockall, Blatchford, and AIMS65 scores in risk stratification for rebleeding and/or mortality associated with AVB. Methods: This retrospective study was conducted at a tertiary care hospital over 42 months. The outcomes were 6-week rebleeding and mortality. The AUROC was calculated for each score (1-0.9, 0.9-0.8, and 0.8-0.7, indicating excellent, good, and acceptable predictive power, respectively). Results: In total, 222 patients were included. Six-week rebleeding and mortality rates were 14% and 18.5%, respectively. No score was useful for discriminating patients at a higher risk of rebleeding. The AUROCs were 0.59, 0.57, 0.61, 0.63, and 0.56 for Rockall, Blatchford, AIMS65, Child, and MELD scores, respectively. Prediction of 6-week mortality based on Rockall (AUROC 0.65), Blatchford (AUROC=0.60), and AIMS65 (AUROC=0.67) scores were also not considered acceptable. The AUROCs for predicting mortality were acceptable for Child and MELD scores (0.72 and 0.74, respectively). Conclusion: Rockall, Blatchford, and AIMS65 scores are not useful for predicting 6-week rebleeding or mortality in patients with AVB. Child and MELD scores can identify patients at higher risk for 6-week mortality but not for 6-week rebleeding.
Databáze:	MEDLINE
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