Bou Daher Halim, Gregoski Mathew J, Rockey Don C
Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA.
Digestive Disease Research Center, Medical University of South Carolina, Charleston, SC, USA.
J Investig Med. 2025 Jun 30:10815589251357622. doi: 10.1177/10815589251357622.
Upper gastrointestinal bleeding (UGIB) is associated with poor outcomes in patients with cirrhosis. Here, we developed a new-and examined previous UGIB predictor models-in cirrhotic patients with UGIB. We analyzed consecutive patients with cirrhosis and UGIB admitted to our center from 2011 to 2018. Predictors of mortality during index admissions were identified using logistic regression and existing scoring system were compared using Area Under the Receiver Operating Characteristic Curve (AUROCs). In addition, classification and regression trees (CART) analyses were conducted with v-fold cross-validation. Three hundred thirty-three patients with cirrhosis were admitted with UGIB; 294 (88%) survived and 39 (12%) expired. Those who expired were more likely to have Child-Pugh C cirrhosis (67% vs 32%, p < 0.001), hypotension, hepatic encephalopathy, and hepatocellular carcinoma. Endoscopic sources of bleeding were similar in both groups, with esophageal varices being the most common culprit lesion. Regression analysis yielded a model including systolic blood pressure, model of end-stage liver disease-sodium (MELD-Na), and alanine aminotransferase on admission as having the best mortality predictive capability (AUROC, 0.83). MELD-Na, MELD 3.0, MELD, Lyles-Rockey, AIMS65, Rockall, and Glasgow-Blatchford scores were all significantly higher in patients who expired vs survivors; of these scoring systems, MELD-Na and MELD were the best predictors of death (AUROCs = 0.81 and 0.80), respectively. In addition, CART identified MELD-Na as the strongest predictor of mortality. The MELD score appears to be an accurate predictor of mortality in patients with cirrhosis and UGIB; since the MELD score is well-established and widely used in patients with cirrhosis, we suggest that it be the primary tool utilized to predict mortality in practice.
上消化道出血（UGIB）与肝硬化患者的不良预后相关。在此，我们开发了一种新的——并检验了先前的UGIB预测模型——用于肝硬化合并UGIB的患者。我们分析了2011年至2018年期间入住我们中心的连续性肝硬化合并UGIB患者。使用逻辑回归确定首次入院期间的死亡预测因素，并使用受试者操作特征曲线下面积（AUROCs）比较现有的评分系统。此外，进行了分类与回归树（CART）分析及v折交叉验证。333例肝硬化患者因UGIB入院；294例（88%）存活，39例（12%）死亡。死亡患者更可能患有Child-Pugh C级肝硬化（67%对32%，p＜0.001）、低血压、肝性脑病和肝细胞癌。两组的内镜下出血来源相似，食管静脉曲张是最常见的病因。回归分析得出一个模型，该模型纳入入院时的收缩压、终末期肝病-钠模型（MELD-Na）和丙氨酸氨基转移酶，其具有最佳的死亡预测能力（AUROC，0.83）。死亡患者的MELD-Na、MELD 3.0、MELD、Lyles-Rockey、AIMS65、Rockall和Glasgow-Blatchford评分均显著高于存活患者；在这些评分系统中，MELD-Na和MELD分别是最佳的死亡预测指标（AUROCs分别为0.81和0.80）。此外，CART分析确定MELD-Na是最强的死亡预测因素。MELD评分似乎是肝硬化合并UGIB患者死亡的准确预测指标；由于MELD评分已得到充分确立且在肝硬化患者中广泛应用，我们建议在实践中它应作为预测死亡的主要工具。
