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

Area of Science:

• Gastroenterology
• Hepatology
• Clinical Risk Stratification

Background:

• Acute variceal bleeding (AVB) is a critical complication of portal hypertension, necessitating accurate risk assessment for adverse outcomes.
• Existing scoring systems (Rockall, Blatchford, AIMS65) are validated for nonvariceal bleeding but their utility in AVB is debated.
• Child-Turcotte-Pugh (Child) and Model for End-stage Liver Disease (MELD) scores are known prognostic indicators in liver disease.

Purpose of the Study:

• To evaluate and compare the performance of Child, MELD, Rockall, Blatchford, and AIMS65 scores in predicting rebleeding and mortality in AVB patients.
• To identify the most effective scoring system for risk stratification in acute variceal bleeding.

Main Methods:

• Retrospective analysis of 222 patients with AVB over 42 months at a tertiary care hospital.
• Assessment of 6-week rebleeding and mortality as primary outcomes.
• Calculation of Area Under the Receiver Operating Characteristic (AUROC) curves for each scoring system to determine predictive power.

Main Results:

• Six-week rebleeding and mortality rates were 14% and 18.5%, respectively.
• No scoring system effectively predicted rebleeding risk in AVB patients (AUROCs ranged from 0.56 to 0.63).
• Child and MELD scores demonstrated acceptable predictive power for 6-week mortality (AUROCs 0.72 and 0.74), while Rockall, Blatchford, and AIMS65 showed poor performance.

Conclusions:

• Rockall, Blatchford, and AIMS65 scores are inadequate for predicting 6-week rebleeding or mortality in patients with AVB.
• Child and MELD scores are valuable for identifying patients at higher risk of 6-week mortality from AVB.
• Neither Child nor MELD scores can reliably predict rebleeding risk in AVB.