title: Value of the APASL severity score in patients with acute variceal bleeding: a single center experience.
abstract: BACKGROUND
  Acute variceal bleeding is a severe complication in patients with cirrhosis. The Asian Pacific Association for Study of the Liver (APASL) severity score was proposed in 2011. This score is used for evaluating the severity of acute variceal bleeding. However, as this score is largely based on expert opinion, it requires validation.
  
  
  OBJECTIVE
  To determine the value of the APASL severity score.
  
  
  METHODS
  We retrospectively reviewed the medical records of patients treated for acute variceal bleeding at Konkuk University Hospital from 2006 to 2011. The APASL severity score, Child-Pugh score, and Model for End-Stage Liver Disease (MELD) score were calculated, and predictive values for treatment failure, rebleeding, and in-hospital mortality were compared by the area under the receiver operating curve (AUROC).
  
  
  RESULTS
  A total of 136 patients were enrolled, and all patients were treated by endoscopic variceal ligation (EVL) and terlipressin combination therapy. Most patients were male (n = 123, 90.4 %), and the most common etiology was alcohol (n = 91, 66.9 %). Thirteen treatment failures, eight rebleedings, and seven in-hospital mortalities occurred. The AUROCs of the APASL severity score, Child-Pugh score, and MELD score were 0.760, 0.681, and 0.607 for treatment failure; 0.660, 0.714, and 0.677 for rebleeding; and 0.872, 0.847, and 0.735 for in-hospital mortality. A significant difference was only observed between the APASL severity score and MELD score for treatment failure (p = 0.0259).
  
  
  CONCLUSIONS
  APASL severity score was a useful method for predicting treatment failure. However, the predictive value for rebleeding and in-hospital mortality were not satisfactory.
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Konkuk University Hospital, Konkuk University School of Medicine, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea.
authors.forename: Go Heun
authors.initials: GH
authors.lastname: Kim
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Konkuk University Hospital, Konkuk University School of Medicine, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea. 93haan@hanmail.net.
authors.forename: Jeong Han
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Konkuk University Hospital, Konkuk University School of Medicine, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea.
authors.forename: Yong Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Konkuk University Hospital, Konkuk University School of Medicine, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea.
authors.forename: Soon Young
authors.initials: SY
authors.lastname: Ko
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Konkuk University Hospital, Konkuk University School of Medicine, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea.
authors.forename: Won Hyeok
authors.initials: WH
authors.lastname: Choe
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Konkuk University Hospital, Konkuk University School of Medicine, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea.
authors.forename: So Young
authors.initials: SY
authors.lastname: Kwon
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Konkuk University Hospital, Konkuk University School of Medicine, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea.
authors.forename: Chang Hong
authors.initials: CH
authors.lastname: Lee
keywords: In-hospital mortality; Rebleeding; Treatment failure; Variceal bleeding