title: Assessing the short- and long-term prognosis of patients with cirrhosis and acute variceal bleeding.
abstract: OBJECTIVE
  to evaluate the efficacy of various indicators in predicting short- and long-term survival in patients with cirrhosis and acute variceal bleeding.
  
  
  METHODS
  prognostic indicators were calculated for a cohort of 201 cirrhotic patients with acute variceal bleeding hospitalized in our center, a third-level teaching hospital. The studied variables were: age, sex, etiology of cirrhosis, endoscopic findings, previous variceal bleeding episodes, human immunodeficiency virus (HIV) infection, hepatocellular carcinoma (HCC), infection during episode, and Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease (MELD) scores within 24 hours of bleeding onset. Patients were followed up for at least 6 months until death, liver transplantation, or end of observation.
  
  
  RESULTS
  median follow-up was 66.85 weeks (range 0-432.4). The 6-week, 3-month, 12-month and 36-month mortality rates were 22.9, 24.9, 34.3, and 39.8%, respectively. Age >= 65 years, presence of HCC, CTP score >=10, and MELD score >= 18 were the variables associated with mortality in the multivariate analysis. The accuracy of MELD scores as predictors of 6-week, 3-month, 12-month, and 36-month mortality was better than that of CTP scores (c-statistics: 6 week MELD 0.804, CTP 0.762; 3-month MELD 0.794, CTP 0.760; 12-month MELD 0.766, CTP 0.741; 36 month MELD 0.737, CTP 0.717).
  
  
  CONCLUSIONS
  MELD and CTP scores together with age and a diagnosis of hepatocellular carcinoma are useful indicators to assess the short- and long-term prognosis of patients with acute variceal bleeding.
authors.affiliation: Epidemiology Service, Hospital General Universitario, Alicante, Spain. sempere_lau@gva.es
authors.forename: L
authors.initials: L
authors.lastname: Sempere
authors.forename: J M
authors.initials: JM
authors.lastname: Palazón
authors.forename: J
authors.initials: J
authors.lastname: Sánchez-Payá
authors.forename: S
authors.initials: S
authors.lastname: Pascual
authors.forename: E
authors.initials: E
authors.lastname: de Madaria
authors.forename: M J
authors.initials: MJ
authors.lastname: Poveda
authors.forename: F
authors.initials: F
authors.lastname: Carnicer
authors.forename: P
authors.initials: P
authors.lastname: Zapater
authors.forename: M
authors.initials: M
authors.lastname: Pérez-Mateo
mesh_terms: D000208:Acute Disease; D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000401:mortality*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000401:mortality*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors