Adjusted blood requirement index as indicator of failure to control acute variceal bleeding

To estimate the clinical value of adjusted blood requirement index (ABRI) in relation to other criteria for failure of variceal bleeding control proposed at Baveno consensus workshops and to evaluate ABRI as an early predictor of occurrence of other Baveno criteria and identification of possible predictors of unfavorable ABRI.

We retrospectively analyzed the data on 60 patients admitted to the hospital due to acute variceal bleeding. Number of treatment failures according to Baveno II-III and Baveno IV definitions and criteria was compared. We tested the ABRI's predictability of other Baveno IV and Baveno II-III criteria. Logistic regression analysis was performed to ascertain independent variables that predict ABRI> or =0.75.

Failure to control variceal bleeding occurred in 40 of 60 patients according to Baveno II-III criteria, and in 35 of 60 patients according to Baveno IV criteria. Excluding the criterion of "transfusion of 2 units of blood or more (over and above the previous transfusions)" and ABRI criterion, failure to control variceal bleeding was observed in 17 and 14 of 60 patients, respectively. Congruence of ABRI with other criteria was present in about two-thirds of the cases. ABRI> or =0.75 was associated with increased risk of positive other Baveno criteria, particularly modified Baveno II-III (odds ratio [OR] 4.10; 95% confidence interval [CI], 1.11-15.05) and Baveno IV without ABRI (OR 4.37; 95% CI, 1.04-18.28). Independent predictors of ABRI> or =0.75 identified in logistic regression analysis were male sex (P<0.001) and higher hematocrit values (P=0.004).

We found low congruence between ABRI and other Baveno criteria and the incidence of treatment failure in our study was higher than the previously reported frequencies of early rebleeding. It seems that criteria related to the quantity of blood transfusions are not reliable indicators of treatment failure.