Early risk stratification with simple clinical parameters for cirrhotic patients with acute upper gastrointestinal bleeding.
OBJECTIVE
This study aimed to identify pre-endoscopic clinical parameters independently associated with 6-week mortality and to develop a prognostic model in cirrhotic patients with acute upper gastrointestinal (UGI) bleeding.


METHODS
A total of 542 consecutive admissions of 389 cirrhotic patients with acute UGI bleeding were retrospectively investigated. Pertinent clinical data obtained at the emergency department were analyzed. Multivariate logistic regression analysis was performed to determine risk factors for 6-week mortality and to develop a predictive model.


RESULTS
Forty-four patients (8.12%) died within 6 weeks. The 6-week mortality was independently associated with male sex, hepatocellular carcinoma, non-hepatocellular carcinoma malignancy, hypoxemia with peripheral oxygen saturation less than 95%, serum bilirubin, and prothrombin time. A predictive model consisting of these 6 simple parameters was built. The c statistic of our model was 0.84, significantly superior to that (0.71) of the model for end-stage liver disease score (P = .002).


CONCLUSIONS
Simple pre-endoscopic clinical parameters are valuable for early risk stratification in cirrhotic patients with acute UGI bleeding. Our prognostic model warrants prospective validation by further studies.
Hsu
Yao-Chun
YC
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Lotung Poh-Ai Hospital, Yilan, Taiwan.
Liou
Jyh-Ming
JM
Chung
Chen-Shuan
CS
Tseng
Cheng-Hao
CH
Lin
Tzu-Ling
TL
Chen
Chieh-Chang
CC
Wu
Ming-Shiang
MS
Wang
Hsiu-Po
HP
D000368:Aged; D001663:Bilirubin / Q000097:blood; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital; D005260:Female; D006396:Hematemesis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D016017:Odds Ratio; D011379:Prognosis; D011517:Prothrombin Time / Q000706:statistics & numerical data; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors
D001663:Bilirubin