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CN 22-1108/R
Volume 37 Issue 3
Mar.  2021
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Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(3): 590-594

Value of albumin-bilirubin score in predicting the prognosis of cirrhotic patients with esophagogastric variceal bleeding

DOI: 10.3969/j.issn.1001-5256.2021.03.017
  • 1.

    Yangzhou University Medical College, Yangzhou, Jiangsu 225009, China

  • 2.

    Department of Gastroenterology, School of Clinical Medicine, Yangzhou University, Yangzhou, Jiangsu 225001, China

  • Received Date: 2020-09-06
  • Accepted Date: 2020-10-10
  • Published Date: 2021-03-20
    Abstract
  •   Objective  To investigate the value of albumin-bilirubin (ALBI) score in predicting the prognosis of cirrhotic patients with esophagogastric variceal bleeding, and to identify risk stratification and increase clinical applicability.  Methods  A retrospective analysis was performed for the clinical data of 273 cirrhotic patients with esophagogastric variceal bleeding who were hospitalized in Subei People's Hospital of Jiangsu from October 2012 to August 2018, and all patients received standard management after admission. Survival status was obtained through electronic medical records and telephone follow-up, and according to the prognosis in August 2020, the patients were divided into death group with 109 patients and survival group with 164 patients. General data were compared between the two groups. The Mann-Whitney U test was used for comparison of continuous variables between two groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical variables between two groups; univariate and multivariate Cox regression analyses were used to identify independent risk factors for prognosis. The Kaplan-Meier curve was used to analyze the survival rates of patients with different ALBI grades, and the log-rank test was used for comparison between groups; the receiver operating characteristic (ROC) curve was plotted to compare the ability of ALBI score, Child-Turcotte-Pugh (CTP) score, and Model for End-Stage Liver Disease (MELD) score in predicting short-term (6 weeks) and long-term prognoses.  Results  During follow-up, 109 patients (39.9%) died, and the death group had a significantly higher ALBI score than the survival group [-1.49 (-1.82 to-1.11) vs-1.79 (-2.22 to-1.49), Z=5.630, P < 0.001]. The univariate analysis showed that age ≥55 years, hemoglobin ≤100 g/L, neutrophil count ≥3.4×109/L, platelet count ≤42×109/L, albumin ≤28 g/L, total bilirubin ≥21 μmol/L, alanine aminotransferase ≥42 U/L or aspartate aminotransferase ≥48 U/L, creatinine ≥94 μmol/L, serum sodium ≤137 mmol/L, international normalized ratio of prothrombin ≥1.5, ascites, and hepatic encephalopathy were risk factors for death in cirrhotic patients with esophagogastric variceal bleeding, and the patients with ALBI grade 3 had a significantly higher risk of death than those with ALBI grade 1 or 2; prophylactic ligation was a protective factor for survival improvement in cirrhotic patients with esophagogastric variceal bleeding (all P < 0.05). The multivariate analysis showed that age ≥55 years (hazard ratio [HR]=2.531, 95% confidence interval [CI]: 1.624-3.946, P < 0.001), creatinine ≥94 μmol/L (HR=1.935, 95% CI: 1.208-3.100, P=0.006), serum sodium ≤137 mmol/L [HR=1.519, 95% CI: 1.015-2.274, P=0.042], ascites (HR=1.641, 95% CI: 1.041-2.585, P=0.033), hepatic encephalopathy (HR=9.972, 95% CI: 3.961-25.106, P < 0.001), and ALBI grade 3 (HR=1.591, 95% CI: 1.007-2.515, P=0.047) were independent risk factors for death. The patients with ALBI grade 3 had a significantly lower survival rate than those with ALBI grade 1 (χ2=18.691, P < 0.001) and ALBI grade 2 (χ2=21.364, P < 0.001), and the patients with ALBI grade 1 had a significantly higher survival rate than those with ALBI grade 2 (χ2=6.513, P=0.011). The ROC curve analysis showed that ALBI score, CTP score, and MELD score had an area under the ROC curve (AUC) of 0.770, 0.730, and 0.706, respectively, in predicting short-term (6 weeks) prognosis, and they had an AUC of 0.701, 0.685, and 0.659, respectively, in predicting long-term prognosis.  Conclusion  ALBI score has a good value in predicting short-term (6 weeks) and long-term prognoses of cirrhotic patients with esophagogastric variceal bleeding, and the risk of death increases with ALBI grade. ALBI score can be used as an objective and simple model in clinical practice.

     

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    • References(16)
  • [1]
    KOVACS T, JENSEN DM. Varices: Esophageal, gastric, and rectal[J]. Clin Liver Dis, 2019, 23(4): 625-642. DOI: 10.1016/j.cld.2019.07.005
    [2]
    MANDAL AK, PAUDEL MS, KC S, et al. Factors predicting mortality of acute variceal bleeding in liver cirrhosis[J]. JNMA J Nepal Med Assoc, 2018, 56(209): 493-496. DOI: 10.31729/jnma.3408
    [3]
    FORTUNE BE, GARCIA-TSAO G, CIARLEGLIO M, et al. Child-Turcotte-Pugh class is best at stratifying risk in variceal hemorrhage: Analysis of a US multicenter prospective study[J]. J Clin Gastroenterol, 2017, 51(5): 446-453. DOI: 10.1097/MCG.0000000000000733
    [4]
    WANG J, ZHANG Z, YAN X, et al. Albumin-Bilirubin (ALBI) as an accurate and simple prognostic score for chronic hepatitis B-related liver cirrhosis[J]. Dig Liver Dis, 2019, 51(8): 1172-1178. DOI: 10.1016/j.dld.2019.01.011
    [5]
    HSIEH YC, LEE KC, WANG YW, et al. Correlation and prognostic accuracy between noninvasive liver fibrosis markers and portal pressure in cirrhosis: Role of ALBI score[J]. PLoS One, 2018, 13(12): e0208903. DOI: 10.1371/journal.pone.0208903
    [6]
    Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association. The guideline of prevention andtreatment for chronic hepatitis B: A 2015 update[J]. J Clin Hepatol, 2015, 31(12): 1941-1960. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2015.12.002

    中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2015年更新版)[J]. 临床肝胆病杂志, 2015, 31(12): 1941-1960. DOI: 10.3969/j.issn.1001-5256.2015.12.002
    [7]
    XU XY, DING HG, JIA JD, et al. Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J]. J Clin Hepatol, 2016, 32(2): 203-219. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2016.02.002

    徐小元, 丁惠国, 贾继东, 等. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]. 临床肝胆病杂志, 2016, 32(2): 203-219. DOI: 10.3969/j.issn.1001-5256.2016.02.002
    [8]
    JOHNSON PJ, BERHANE S, KAGEBAYASHI C, et al. Assessment of liver function in patients with hepatocellular carcinoma: A new evidence-based approach-the ALBI grade[J]. J Clin Oncol, 2015, 33(6): 550-558. DOI: 10.1200/JCO.2014.57.9151
    [9]
    de FRANCHIS R, Baveno Ⅵ Faculty. Expanding consensus in portal hypertension: Report of the Baveno Ⅵ Consensus Workshop: Stratifying risk and individualizing care for portal hypertension[J]. J Hepatol, 2015, 63(3): 743-752. DOI: 10.1016/j.jhep.2015.05.022
    [10]
    TANTAI XX, LIU N, YANG LB, et al. Prognostic value of risk scoring systems for cirrhotic patients with variceal bleeding[J]. World J Gastroenterol, 2019, 25(45): 6668-6680. DOI: 10.3748/wjg.v25.i45.6668
    [11]
    WU SL, ZHENG YX, TIAN ZW, et al. Scoring systems for prediction of mortality in decompensated liver cirrhosis: A meta-analysis of test accuracy[J]. World J Clin Cases, 2018, 6(15): 995-1006. DOI: 10.12998/wjcc.v6.i15.995
    [12]
    FUJITA K, NOMURA T, MORISHITA A, et al. Prediction of transplant-free survival through albumin-bilirubin score in primary biliary cholangitis[J]. J Clin Med, 2019, 8(8): 1258. DOI: 10.3390/jcm8081258
    [13]
    Chinese Society of Hepatogy, Chinese MedicalAssociation. Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35(11): 2408-2425. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2019.11.006

    中华医学会肝病学分会. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006
    [14]
    PUENTE A, HERNÁNDEZ-GEA V, GRAUPERA I, et al. Drugs plus ligation to prevent rebleeding in cirrhosis: An updated systematic review[J]. Liver Int, 2014, 34(6): 823-833. DOI: 10.1111/liv.12452
    [15]
    BRUNNER F, BERZIGOTTI A, BOSCH J. Prevention and treatment of variceal haemorrhage in 2017[J]. Liver Int, 2017, 37(Suppl 1): 104-115. http://www.ncbi.nlm.nih.gov/pubmed/28052623
    [16]
    Chinese Society of Spleen and Portal Hypertension Surgery, Chinese Society of Surgery, Chinese Medical Association. Expert consensus on diagnosis and treatment of esophagogastric variceal bleeding in cirrhotic portal hypertension (2019 edition)[J]. Chin J Dig Surg, 2019, 18(12): 1087-1093. (in Chinese)

    中华医学会外科学分会脾及门静脉高压外科学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版)[J]. 中华消化外科杂志, 2019, 18(12): 1087-1093.
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