Cazacu Sergiu Marian, Alexandru Dragos Ovidiu, Popescu Alexandru Valentin, Popa Petrica, Rogoveanu Ion, Iovanescu Vlad Florin
Gastroenterology Department, University of Medicine and Pharmacy Craiova, Emergency Clinical Hospital Craiova, 200642 Craiova, Romania.
Biostatistics Department, University of Medicine and Pharmacy Craiova, Emergency Clinical Hospital Craiova, 200642 Craiova, Romania.
Diseases. 2025 Aug 16;13(8):265. doi: 10.3390/diseases13080265.
(1) Background: Acute variceal bleeding (AVB) represents an important cause of upper gastrointestinal bleeding (UGIB). Several prognostic scores may be useful for assessing mortality and rebleeding risk, with the Glasgow-Blatchford score (GBS) and Rockall score being the most commonly used for non-variceal bleeding. Scores assessing liver failure (MELD and Child) do not reflect bleeding severity. The neutrophil-to-lymphocyte ratio (NLR) increases in UGIB and can predict survival and rebleeding. (2) Methods: We analyzed the predictive role of NLR, GBS, Rockall, AIMS65, Child, and MELD for mortality (48 h, 5-day, in-hospital, and 6-week) and rebleeding in AVB patients admitted to our hospital from 2017 to 2021. ROC analysis was performed, and a multivariate analysis with logistic regression was used to construct a simplified model. (3) Results: A total of 415 patients were admitted. NLR exhibited fair accuracy for 48-h mortality (AUC 0.718, 95% CI 0.597-0.839, < 0.0001), with limited predictive value for medium-term mortality. The NLR accuracy was better than that of the GBS and Rockall score, similar to that of the AIMS65 and Child scores, but inferior to that of MELD. The value for all scores in predicting rebleeding was poor, with the highest AUC for the NLR. (4) Conclusions: The NLR exhibited reasonable accuracy in predicting short-term mortality in AVB. Our model (including NLR, age, creatinine, bilirubin, albumin, INR, platelet count, HCC, and etiology) demonstrated 80.72% accuracy in predicting 6-week mortality.
(1) 背景：急性静脉曲张出血（AVB）是上消化道出血（UGIB）的一个重要原因。几种预后评分可能有助于评估死亡率和再出血风险，格拉斯哥-布拉奇福德评分（GBS）和罗卡尔评分是最常用于非静脉曲张出血的评分。评估肝功能衰竭的评分（MELD和Child）不能反映出血严重程度。中性粒细胞与淋巴细胞比值（NLR）在UGIB中升高，可预测生存率和再出血情况。(2) 方法：我们分析了NLR、GBS、罗卡尔评分、AIMS65评分、Child评分和MELD评分对2017年至2021年我院收治的AVB患者死亡率（48小时、5天、住院期间和6周）和再出血的预测作用。进行了ROC分析，并使用逻辑回归进行多变量分析以构建简化模型。(3) 结果：共收治415例患者。NLR对48小时死亡率具有较好的准确性（AUC 0.718，95%CI 0.597 - 0.839，<0.0001），对中期死亡率的预测价值有限。NLR的准确性优于GBS和罗卡尔评分，与AIMS65评分和Child评分相似，但不如MELD评分。所有评分对再出血的预测价值都很差，NLR的AUC最高。(4) 结论：NLR在预测AVB短期死亡率方面具有合理的准确性。我们的模型（包括NLR、年龄、肌酐、胆红素、白蛋白、INR、血小板计数、肝癌和病因）在预测6周死亡率方面的准确率为80.72%。
