title: MELD score can predict early mortality in patients with rebleeding after band ligation for variceal bleeding.
abstract: OBJECTIVE
  To investigate the outcomes, as well as risk factors for 6-wk mortality, in patients with early rebleeding after endoscopic variceal band ligation (EVL) for esophageal variceal hemorrhage (EVH).
  
  
  METHODS
  Among 817 EVL procedures performed for EVH between January 2007 and December 2008, 128 patients with early rebleeding, defined as rebleeding within 6 wk after EVL, were enrolled for analysis.
  
  
  RESULTS
  The rate of early rebleeding after EVL for acute EVH was 15.6% (128/817). The 5-d, 6-wk, 3-mo, and 6-mo mortality rates were 7.8%, 38.3%, 55.5%, and 58.6%, respectively, in these early rebleeding patients. The use of beta-blockers, occurrence of hypovolemic shock, and higher model for end-stage liver disease (MELD) score at the time of rebleeding were independent predictors for 6-wk mortality. A cut-off value of 21.5 for the MELD score was found with an area under ROC curve of 0.862 (P < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value were 77.6%, 81%, 71.7%, and 85.3%, respectively. As for the 6-mo survival rate, patients with a MELD score ≥ 21.5 had a significantly lower survival rate than patients with a MELD score < 21.5 (P < 0.001).
  
  
  CONCLUSIONS
  This study demonstrated that the MELD score is an easy and powerful predictor for 6-wk mortality and outcomes of patients with early rebleeding after EVL for EVH.
authors.affiliation: Department of Hepato-Gastroenterology, Linkou Medical Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taipei, Taiwan, China.
authors.forename: Wei-Ting
authors.initials: WT
authors.lastname: Chen
authors.forename: Chun-Yen
authors.initials: CY
authors.lastname: Lin
authors.forename: I-Shyan
authors.initials: IS
authors.lastname: Sheen
authors.forename: Chang-Wen
authors.initials: CW
authors.lastname: Huang
authors.forename: Tsung-Nan
authors.initials: TN
authors.lastname: Lin
authors.forename: Chun-Jung
authors.initials: CJ
authors.lastname: Lin
authors.forename: Wen-Juei
authors.initials: WJ
authors.lastname: Jeng
authors.forename: Chien-Hao
authors.initials: CH
authors.lastname: Huang
authors.forename: Yu-Pin
authors.initials: YP
authors.lastname: Ho
authors.forename: Cheng-Tang
authors.initials: CT
authors.lastname: Chiu
mesh_terms: D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000209:etiology / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000401:mortality* / Q000517:prevention & control* / Q000601:surgery; D006801:Humans; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome