Development and validation of a scoring system for in-hospital mortality following band ligation in esophageal variceal bleeding.

Autor: Ichita C; Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan.; Department of Health Data Science, Yokohama City University, Kanagawa, Japan., Goto T; Department of Health Data Science, Yokohama City University, Kanagawa, Japan.; TXP Research, TXP Medical Co., Ltd, Tokyo, Japan.; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan., Okada Y; Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan.; Health Services and Systems Research, Duke-NUS Medical School, Singapore City, Singapore., Uojima H; Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan.; Department of Genome Medical Sciences Project, Research Institute, National Center for Global Health and Medicine, Chiba, Japan., Iwagami M; Department of Health Services Research, Institute of Medicine, University of Tsukuba, Chiba, Japan., Sasaki A; Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan., Shimizu S; Department of Health Data Science, Yokohama City University, Kanagawa, Japan.
Jazyk: angličtina
Zdroj: Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society [Dig Endosc] 2024 Oct; Vol. 36 (10), pp. 1105-1114. Date of Electronic Publication: 2024 Mar 11.
DOI: 10.1111/den.14773
Abstrakt: Objectives: We aimed to develop and validate a simple scoring system to predict in-hospital mortality after endoscopic variceal ligation (EVL) for esophageal variceal bleeding.
Methods: Data from a 13-year study involving 46 Japanese institutions were split into development (initial 7 years) and validation (last 6 years) cohorts. The study subjects were patients hospitalized for esophageal variceal bleeding and treated with EVL. Variable selection was performed using least absolute shrinkage and selection operator regression, targeting in-hospital all-cause mortality as the outcome. We developed the Hospital Outcome Prediction following Endoscopic Variceal Ligation (HOPE-EVL) score from β coefficients of multivariate logistic regression and assessed its discrimination and calibration.
Results: The study included 980 patients: 536 in the development cohort and 444 in the validation cohort. In-hospital mortality was 13.6% and 10.1% for the respective cohorts. The scoring system used five variables: systolic blood pressure (<80 mmHg: 2 points), Glasgow Coma Scale (≤12: 1 point), total bilirubin (≥5 mg/dL: 1 point), creatinine (≥1.5 mg/dL: 1 point), and albumin (<2.8 g/dL: 1 point). The risk groups (low: 0-1, middle: 2-3, high: ≥4) in the validation cohort corresponded to observed and predicted mortality probabilities of 2.0% and 2.5%, 19.0% and 22.9%, and 57.6% and 71.9%, respectively. In this cohort, the HOPE-EVL score demonstrated excellent discrimination ability (area under the curve [AUC] 0.890; 95% confidence interval [CI] 0.850-0.930) compared with the Model for End-stage Liver Disease score (AUC 0.853; 95% CI 0.794-0.912) and the Child-Pugh score (AUC 0.798; 95% CI 0.727-0.869).
Conclusions: The HOPE-EVL score practically and effectively predicts in-hospital mortality. This score could facilitate the appropriate allocation of resources and effective communication with patients and their families.
(© 2024 Japan Gastroenterological Endoscopy Society.)
Databáze: MEDLINE
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