Eshkiki Zahra Shokati, Khazaei Razieh, Parsi Abazar, Shayesteh Ali Akbar
Alimentary Tract Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Arq Gastroenterol. 2025 Sep 5;62:e24075. doi: 10.1590/S0004-2803.24612024-075. eCollection 2025.
Acute upper gastrointestinal bleeding (AUGIB) is a critical medical emergency and is a common cause of illness and death in individuals with liver cirrhosis.
The point of this study was to check how well the albumin-to-bilirubin ratio (ALBI) and model for end-stage liver disease (MELD) scores could predict how these patients would do in the future.
The Imam Khomeini Hospital gastroenterology department conducted a retrospective examination. We admitted 102 patients with AUGIB and liver cirrhosis from April 2021 to September 2023. The study included a full medical history and clinical evaluation upon admission, as well as all laboratory test results throughout the hospital stay. We diagnosed liver cirrhosis using clinical, laboratory, and radiologic data. We diagnosed AUGIB as having hematemesis, melena, or hematochezia. We then tested the ALBI, MELD, and liver and kidney function. Some criteria allow continuous variable comparison, whereas others allow discrete variable comparison. Death during hospitalization and rebleeding were the key outcomes, with one-month mortality assessed. We compared ALBI and MELD before establishing their relationship to mortality and rebleeding.
Of the 102 patients, 68.5% survived. Upon arrival, we noted a markedly elevated prevalence of edema, ascites, and chilly extremities among patients who did not survive. The MELD and ALBI scoring systems effectively forecast in-hospital mortality. The threshold for MELD is 21 (CI: 0.759-0.930, P=0.00), whereas for ALBI it is -2.3 (CI: 0.865-0.950, P=0.01). Neither party could foresee hospitalization or premature rebleeding. The probability of death may be forecasted using the MELD during the first discharge phase (P<0.05).
The MELD and ALBI scores show a suitable ability to predict short-term outcomes and both of them can predict death and rebleeding, as well as 1-month mortality. Nevertheless, we recommend that in individuals with advanced liver cirrhosis, the MELD score is a more accurate prognostic indicator compared to the ALBI score.
急性上消化道出血（AUGIB）是一种严重的医疗急症，是肝硬化患者发病和死亡的常见原因。
本研究旨在检验白蛋白与胆红素比值（ALBI）和终末期肝病模型（MELD）评分对这些患者未来病情的预测能力。
伊玛目·霍梅尼医院胃肠病科进行了一项回顾性研究。我们纳入了2021年4月至2023年9月期间102例患有AUGIB和肝硬化的患者。该研究包括入院时的完整病史和临床评估，以及住院期间的所有实验室检查结果。我们使用临床、实验室和放射学数据诊断肝硬化。我们将AUGIB诊断为有呕血、黑便或便血。然后我们检测了ALBI、MELD以及肝肾功能。一些标准允许连续变量比较，而其他标准允许离散变量比较。住院期间死亡和再出血是关键结局，并评估了1个月死亡率。在确定ALBI和MELD与死亡率和再出血的关系之前，我们对它们进行了比较。
102例患者中，68.5%存活。入院时，我们注意到未存活患者中水肿、腹水和四肢发冷的患病率明显升高。MELD和ALBI评分系统有效地预测了住院死亡率。MELD的阈值为21（CI：0.759 - 0.930，P = 0.00），而ALBI的阈值为 - 2.3（CI：0.865 - 0.950，P = 0.01）。两者均无法预测住院或过早再出血。在首次出院阶段，使用MELD可以预测死亡概率（P < 0.05）。
MELD和ALBI评分显示出预测短期结局的适当能力，两者都可以预测死亡、再出血以及1个月死亡率。然而，我们建议在晚期肝硬化患者中，与ALBI评分相比，MELD评分是更准确的预后指标。
