A simple clinical score predicts high risk for upper gastrointestinal hemorrhages from varices in patients with chronic liver disease.
OBJECTIVE
Upper gastrointestinal (GI) bleeding from esophageal or gastric fundus varices is a common complication of portal hypertension in liver cirrhosis and carries a high mortality rate of 20-35%. Stratifying high-risk patients for variceal bleeding is mainly based on endoscopic scoring. The purpose of this study was to develop a simple clinical score to assess the bleeding risk.


METHODS
A total of 111 patients with chronic liver diseases were included during evaluation for potential liver transplantation and were followed for 6 years. Findings at study entry were analyzed for their value in predicting hemorrhages.


RESULTS
Twenty-four patients (22%) developed upper GI hemorrhages from varices during the follow-up period. Common characteristics at study entry of patients with future bleedings included viral hepatitis or alcoholic etiology, advanced-stage cirrhosis, decreased liver function, impaired hemostasis and endoscopic presence of varices. These parameters were also independent predictors of bleedings. A four-item Bleeding Risk Score, including cholinesterase <2.25 kU/l, international normalized ratio (INR) >1.2, viral or alcoholic etiology and presence of varices, was used to identify patients at high (>2 points) or low (<or=2) risk of bleedings, and found superior in sensitivity and specificity to the Child-Pugh or MELD score.


CONCLUSIONS
A simple clinical score can predict the risk for upper GI bleedings in patients with chronic liver disease. This Bleeding Risk Score may help to supplement current endoscopic and clinical approaches to identify high-risk patients.
Tacke
Frank
F
Medical Clinic III, University Hospital Aachen, Aschen, Germany. frank.tacke@gmx.net
Fiedler
Kai
K
Trautwein
Christian
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D005858:Germany; D006801:Humans; D008107:Liver Diseases / Q000150:complications* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D013997:Time Factors
D015415:Biomarkers