Development and validation of prognostic model to predict mortality among cirrhotic patients with acute variceal...

Acute variceal bleeding (AVB) is a serious complication associated with high mortality. The aim of our study was to investigate mortality predictors and to develop a new simplified prognostic model among cirrhotic patients with AVB.

A simplified prognostic model was developed using multiple logistic regression after identifying significant predictors of 6-week mortality.

A total of 713 consecutive patients with AVB were enrolled. The 6-week overall mortality rate was 18%. Multivariate analysis showed that shock, model for end-stage liver disease (MELD) score, high-risk stigmata of esophageal varices on endoscopic finding, and Glasgow Blatchford score were independent predictors of mortality. A new logistic model using these variables was developed. This model (cutoff value ≥ 4) area under the receiver operating characteristics (AUROC) was 0.93 and significantly higher than that of MELD score alone (0.74). Two validation analyses showed that the AUROC of our model was consistently high. The 6-week rebleeding rate was 25.3%. Multivariate analysis showed that MELD score, Glasgow Blatchford score, history of upper GI bleeding, shock, and alcohol use were independent predictors of rebleeding.

Our new simplified model accurately and consistently predicted 6-week mortality among patients with AVB using objective variables measured at admission. Patients with higher MELD scores should be closely monitored due to the higher probability of 6-week rebleeding.