Gyanranjan Rout1, Sanchit Sharma1, Deepak Gunjan1, Saurabh Kedia1, Anoop Saraya1, Baibaswata Nayak1, Vishwajeet Singh2, Ramesh Kumar3. 1. Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110029, India. 2. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India. 3. Department of Gastroenterology, All India Institute of Medical Sciences, Patna, 801507, India.
Abstract
BACKGROUND: Acute variceal bleeding (AVB) in patients with cirrhosis is associated with high mortality, ranging from 12 to 20% at 6 weeks. The existing prognostic models for AVB lack precision and require further validation. AIM: In this prospective study, we aimed to develop and validate a new prognostic model for AVB, and compared it with the existing models. METHODS: We included 285 patients from March 2017 to November 2017 in the derivation cohort and 238 patients from December 2017 to June 2018 in the validation cohort. Two prognostic models were developed from derivation cohort by logistic regression analysis. Discrimination was assessed using area under the receiver operator characteristic curve (AUROC). RESULTS: The 6-week mortality was 22.1% in derivation cohort and 22.3% in validation cohort, P = 0.866. Model for end-stage liver disease (MELD) [odds ratio (OR) 1.106] and encephalopathy (E) (OR 4.658) in one analysis and Child-Pugh score (OR 1.379) and serum creatinine (OR 1.474) in another analysis were significantly associated with 6-week mortality. MELD-E model (AUROC 0.792) was superior to Child-creatinine model (AUROC) in terms of discrimination. The MELD-E model had highest AUROC; as compared to other models-MELD score (AUROC 0.751, P = 0.036), Child-Pugh score (AUROC 0.737, P = 0.037), D'Amico model (AUROC 0.716, P = 0.014) and Augustin model (AUROC 0.739, P = 0.018) in derivation cohort. In validation cohort, the discriminatory performance of MELD-E model (AUROC 0.805) was higher as compared to other models including MELD score (AUROC 0.771, P = 0.048), Child-Pugh score (AUROC 0.746, P = 0.011), Augustin model (AUROC 0.753, P = 0.039) and D'Amico model (AUROC 0.736, P = 0.021). CONCLUSION: In cirrhotic patients with AVB, the novel MELD-Encephalopathy model predicts 6 weeks mortality with higher accuracy than the existing prognostic models.
BACKGROUND: Acute variceal bleeding (AVB) in patients with cirrhosis is associated with high mortality, ranging from 12 to 20% at 6 weeks. The existing prognostic models for AVB lack precision and require further validation. AIM: In this prospective study, we aimed to develop and validate a new prognostic model for AVB, and compared it with the existing models. METHODS: We included 285 patients from March 2017 to November 2017 in the derivation cohort and 238 patients from December 2017 to June 2018 in the validation cohort. Two prognostic models were developed from derivation cohort by logistic regression analysis. Discrimination was assessed using area under the receiver operator characteristic curve (AUROC). RESULTS: The 6-week mortality was 22.1% in derivation cohort and 22.3% in validation cohort, P = 0.866. Model for end-stage liver disease (MELD) [odds ratio (OR) 1.106] and encephalopathy (E) (OR 4.658) in one analysis and Child-Pugh score (OR 1.379) and serum creatinine (OR 1.474) in another analysis were significantly associated with 6-week mortality. MELD-E model (AUROC 0.792) was superior to Child-creatinine model (AUROC) in terms of discrimination. The MELD-E model had highest AUROC; as compared to other models-MELD score (AUROC 0.751, P = 0.036), Child-Pugh score (AUROC 0.737, P = 0.037), D'Amico model (AUROC 0.716, P = 0.014) and Augustin model (AUROC 0.739, P = 0.018) in derivation cohort. In validation cohort, the discriminatory performance of MELD-E model (AUROC 0.805) was higher as compared to other models including MELD score (AUROC 0.771, P = 0.048), Child-Pugh score (AUROC 0.746, P = 0.011), Augustin model (AUROC 0.753, P = 0.039) and D'Amico model (AUROC 0.736, P = 0.021). CONCLUSION: In cirrhotic patients with AVB, the novel MELD-Encephalopathy model predicts 6 weeks mortality with higher accuracy than the existing prognostic models.
Authors: Irene Conejo; Maria Anna Guardascione; Puneeta Tandon; Alba Cachero; Josep Castellote; Juan G Abraldes; Lucio Amitrano; Joan Genescà; Salvador Augustin Journal: Clin Gastroenterol Hepatol Date: 2017-05-10 Impact factor: 11.382
Authors: Yeon Seok Seo; Soo Young Park; Moon Young Kim; Ju Hyun Kim; Jun Yong Park; Hyung Joon Yim; Byoung Kuk Jang; Hong Soo Kim; Taeho Hahn; Byung Ik Kim; Jeong Heo; Hyonggin An; Won Young Tak; Soon Koo Baik; Kwang Hyub Han; Jae Seok Hwang; Sang Hoon Park; Mong Cho; Soon Ho Um Journal: Hepatology Date: 2014-07-25 Impact factor: 17.425
Authors: Richard Moreau; Rajiv Jalan; Pere Gines; Marco Pavesi; Paolo Angeli; Juan Cordoba; Francois Durand; Thierry Gustot; Faouzi Saliba; Marco Domenicali; Alexander Gerbes; Julia Wendon; Carlo Alessandria; Wim Laleman; Stefan Zeuzem; Jonel Trebicka; Mauro Bernardi; Vicente Arroyo Journal: Gastroenterology Date: 2013-03-06 Impact factor: 22.682
Authors: Salvador Augustin; Laura Muntaner; José T Altamirano; Antonio González; Esteban Saperas; Joan Dot; Monder Abu-Suboh; Josep R Armengol; Joan R Malagelada; Rafael Esteban; Jaime Guardia; Joan Genescà Journal: Clin Gastroenterol Hepatol Date: 2009-08-21 Impact factor: 11.382
Authors: Juan G Abraldes; Cándid Villanueva; Rafael Bañares; Carles Aracil; Maria Vega Catalina; Juan Carlos Garci A-Pagán; Jaime Bosch Journal: J Hepatol Date: 2007-11-26 Impact factor: 25.083
Authors: Adnan Said; John Williams; Jeremy Holden; Patrick Remington; Ronald Gangnon; Alexandru Musat; Michael R Lucey Journal: J Hepatol Date: 2004-06 Impact factor: 25.083