A Risk Stratification Score for Predicting First Episode of Upper Gastrointestinal Bleeding in Patients With Cirrhosis

Abstract

Background and Aims

Although endoscopy is the standard method for diagnosing esophageal varices (EV), it is only available in developed countries. This study aims to identify predictors of the initial variceal bleeding (VB) occurrence and to develop a scoring system to predict the VB in patients with cirrhosis.

Methods

This study analyzed 236 patients with cirrhosis who experienced their first upper gastrointestinal bleeding (UGIB) episode. A logistic regression model was used to identify independent risk factors for VB and create a scoring system. We assessed the predictive ability of the scoring system using the area under the receiver operating characteristic curve (AUC-ROC).

Results

Of the included patients, 154 had EV as the bleeding source. The following were identified as independent risk factors for the first VB episode: age over 60 years, diabetes mellitus (DM), absence of ischemic heart disease, platelets below 130,000/uL, albumin >2.9 g/dL, bilirubin level >1.4 mg/dL, and Child-Pugh score B. A score was developed by assigning points to each risk factor and summing the total score (maximum 7 points). This score was categorized into three risk groups: low risk <3 points; intermediate risk 3–4 points; and high risk ≥5 points. The performance score was assessed using AUC-ROC analysis. Both the low- and high-risk categories had high sensitivity but low specificity, while the intermediate-risk group had balanced sensitivity and specificity.

Conclusion

Our score is a valuable noninvasive tool for predicting the first VB episode. It helps determine the urgency of endoscopy and the need for aggressive management strategies.