title: Predictors of early rebleeding and mortality after acute variceal hemorrhage in patients with cirrhosis.
abstract: Despite improvements over the past 20 years in patient survival following episodes of acute variceal hemorrhage (AVH) secondary to cirrhosis, AVH is still associated with a high rate of mortality. The ability to predict which patients are at high risk of death, or which are not likely to respond to standard therapy at admission to hospital is important, as it enables the immediate initiation of vasoactive drugs, early endoscopic intervention and prophylactic antibiotics. This commentary discusses a study that attempts to predict early rebleeding and mortality after AVH in patients with cirrhosis using the Model for End-stage Liver Disease. In this study, the model was a significant predictor of mortality; however, several defects in the study's design limit the conclusions that can be drawn from it. The model described in this study is neither more useful, nor more accurate, than those previously published for the prediction of rebleeding and mortality in patients with AVH.
authors.affiliation: The Royal Free Sheila Sherlock Liver Centre and Department of Surgery, University College London, Royal Free Hospital, Pond Street, London, UK. andrew.burroughs@royalfree.nhs.uk
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
authors.forename: Christos K
authors.initials: CK
authors.lastname: Triantos
authors.forename: James
authors.initials: J
authors.lastname: O'Beirne
authors.forename: David
authors.initials: D
authors.lastname: Patch
mesh_terms: D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000401:mortality; D005544:Forecasting; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000401:mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D012008:Recurrence; D012307:Risk Factors