Predicting 6-week mortality after acute variceal bleeding: role of Classification and Regression Tree analysis.
BACKGROUND
Available prognostic scores for mortality after acute variceal bleeding are mainly based on logistic regression analysis but may have some limitations that can restrict their clinical value.


OBJECTIVE
To assess the efficacy of a novel prognostic approach based on Classification and Regression Tree -CART- analysis to common easy-to-use models (MELD and Child-Pugh) for predicting 6-week mortality in patients with variceal bleeding.


METHODS
Sixty consecutive cirrhotic patients with acute variceal bleeding. CART analysis, MELD and Child-Pugh scores were performed to assess 6-week mortality. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive performance of the models.


RESULTS
Six-week rebleeding and mortality were 30% and 22%, respectively. Child-Pugh and MELD scores were clinically relevant for predicting 6 weeks mortality. CART analysis provided a simple algorithm based on just three bedside-available variables (albumin, bilirubin and in-hospital rebleeding), allowing accurate discrimination of two distinct prognostic subgroups with 3% and 80% mortality rates. All MELD, Child-Pugh and CART models showed excellent and comparable predictive accuracy, with areas under the ROC curves (AUROC) of 0.88, 0.84 and 0.91, respectively.


CONCLUSIONS
A simple CART algorithm combining albumin, bilirubin and in-hospital rebleeding allows an accurate predictive assessment of 6-week mortality after acute variceal bleeding.
Altamirano
José
J
Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca, Vall d'Hebron, Spain. dr_altamirano@hotmail.com
Zapata
Laura
L
Agustin
Salvador
S
Muntaner
Laura
L
González-Angulo
Alberto
A
Ortiz
Ana Laura
AL
Degiau
Louis
L
Garibay
Juan
J
Camargo
Leonardo
L
Genescà
Joan
J
D000328:Adult; D000465:Algorithms; D001663:Bilirubin / Q000097:blood; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D013997:Time Factors
D012709:Serum Albumin; D001663:Bilirubin