Value of Child-Pugh score,Model for End-Stage Liver Disease score,MELD combined with serum sodium concentration,APASAL score,and R-score in predicting rebleeding and death in cirrhotic patients with esophagogastric variceal bleeding

Objective To investigate the value of Child-Pugh score,Model for End-Stage Liver Disease( MELD) score,MELD combined with serum sodium concentration( MELD-Na score),APASAL score,and R-score in predicting rebleeding and death in cirrhotic patients with esophagogastric variceal bleeding. Methods The patients with liver cirrhosis and gastroesophageal variceal bleeding who underwent endoscopic therapy for bleeding for the first time in Beijing Ditan Hospital,Capital Medical University,from January 2013 to January 2016 and were followed up for more than 3 years were enrolled. Observation indices included age,sex,body weight,blood pressure,routine blood test results,hepatic and renal function,coagulation,radiological examination( including abdominal ultrasound),and complications( including hepatic encephalopathy,ascites,and infection). Variceal rebleeding was the primary endpoint,and death was the secondary endpoint. The t-test or the Wilcoxon rank-sum test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. A Spearman correlation analysis was performed,and the receiver operating characteristic( ROC) curve was used to investigate the value of these five risk scoring systems in the diagnosis of rebleeding and death. Results A total of 305 patients were enrolled,among whom 53( 17. 38%) experienced variceal rebleeding during follow-up. There were significant differences between the rebleeding group and the non-rebleeding group in age,alanine aminotransferase,direct bilirubin,international normalized ratio,diameter of the portal vein,MELD score,MELD-Na score,and R-score( all P < 0. 05). The correlation analysis showed a significant correlation between any two scores except between APASAL score and MELD score/R-score and between MELD-Na score and R-score( all P < 0. 05). The ROC curve analysis showed that MELD score,MELD-Na score,and R-score had a certain value in predicting rebleeding,with an area under the ROC curve( AUC) of 0. 645( 95% confidence interval [CI]: 0. 563-0. 727,P = 0. 001),0. 637( 95% CI: 0. 552-0. 723,P = 0. 002),and 0. 647( 95% CI: 0. 565-0. 729,P = 0. 001),respectively,and Child-Pugh score had a certain diagnostic value for death,with an AUC of 0. 610( 95% CI: 0. 541-0. 680,P = 0. 002). Conclusion Child-Pugh score,MELD score,MELD-Na score,APASAL score,and R-score have a limited value in predicting variceal rebleeding,and only Child-Pugh score has a certain diagnostic value for death.