A New Recalibrated Four-Category Child–Pugh Score Performs Better than the Original Child–Pugh and MELD Scores in Predicting In-Hospital Mortality in Decompensated Alcoholic Cirrhotic Patients with Acute Variceal Bleeding: a Real-World Cohort Analysis
| Autor: | Eduard Jonas, Jake E. J. Krige, Marius Hoogerboord, James Ellsmere, Richard Trafford Spence |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Alcoholic liver disease Esophageal and Gastric Varices Gastroenterology Cohort Studies End Stage Liver Disease 03 medical and health sciences Liver disease 0302 clinical medicine Liver Cirrhosis Alcoholic Internal medicine medicine Humans Hospital Mortality Prospective Studies Prospective cohort study Aged Aged 80 and over business.industry Middle Aged Vascular surgery medicine.disease Cardiac surgery Cardiothoracic surgery 030220 oncology & carcinogenesis Acute Disease Female 030211 gastroenterology & hepatology Surgery Gastrointestinal Hemorrhage business Abdominal surgery Cohort study |
| Zdroj: | World Journal of Surgery. 44:241-246 |
| ISSN: | 1432-2323 0364-2313 |
| DOI: | 10.1007/s00268-019-05211-8 |
| Popis: | There currently is no consensus on how to accurately predict early rebleeding and death after a major variceal bleed. This study investigated the relative predictive performances of the original Child–Pugh (CP), model for end-stage liver disease (MELD) and a four-category recalibrated Child–Pugh (rCP). This prospective study included all adult patients admitted to Groote Schuur Hospital with acute esophageal variceal bleeding secondary to alcoholic cirrhosis, between January 2000 and December 2017. CP and rCP grades and MELD score were calculated on admission, and the predictive ability in discriminating in-hospital rebleeding and death was compared by area under receiver-operating characteristic (AUROC) curves. During the study period, 403 consecutive adult patients were treated for bleeding esophageal varices of whom 225 were secondary to alcoholic cirrhosis. Twenty-four (10.6%) patients were CP grade A, 88 (39.1%) grade B and 113 (50.2%) grade C on hospital admission. MELD scores ranged from 6 to 40. Thirty-one (13.8%) patients rebleed, and 41 (18.2%) patients died. There was no difference in the discriminatory capacity of the CP (AUROC 0.59, 95% CI 0.50–0.670) and MELD (AUROC 0.62, 95% CI 0.51–0.73) to predict rebleeding (p = 0.72), or between the Child–Pugh (AUROC 0.75, 95% CI 0.71–0.81) and MELD (AUROC 0.71, 95% CI 0.62–0.80) to predict death (p = 0.35). The rCP classification (A–D) had a significantly improved discriminatory capacity (AUROC 0.83 95% CI 0.77–0.89) compared to the CP score (A–C) and MELD to predict death (p = 0.004). A recalibrated Child–Pugh score outperforms the original Child–Pugh grade and MELD score in predicting in-hospital death in patients with bleeding esophageal varices secondary to alcoholic cirrhosis. |
| Databáze: | OpenAIRE |
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