Predicting mortality for cirrhotic patients with acute oesophageal variceal haemorrhage using liver-specific scores

Background

Acute oesophageal variceal haemorrhage (AOVH) is one of the most common complications of cirrhosis, treated with terlipressin plus endoscopic variceal banding. Identifying patients with a high chance to survive is paramount in order to allocate resources with accuracy. The purpose of this study was to analyse if liver-specific scores are capable of prognosticating mortality for AOVH patients.

Design and setting

Historical cohort study was conducted in a public tertiary care teaching hospital.

Methods

Data from medical records from 2010 to 2016 were obtained by searching the hospital electronic database patients who received terlipressin. Charts were reviewed in order to determine the diagnosis of cirrhosis and AOVH. Data in these charts were reviewed and multiple variables were collected. The study included 97 patients. Liver-specific scores were calculated and ROC-curves pairwise comparisons were performed using DeLong test.

Results

Model for End-Stage Liver Disease-Sodium (MELD-Na) was able to predict mortality in 30 and 90-day, with AUROC of 0.76 and 0.78 respectively. Values of MELD-Na above 17 were able to predict higher mortality for all patients, with the sensitivity of 69% and 67% and the specificity of 75% and 77% for 30 and 90-day mortality respectively (P < 0.05). Although, when stratifying for acute-on-chronic liver failure patients, Chronic Liver-Failure-Sequential Organ Failure Assessment (CLIF-SOFA) performed better than other liver-specific scores, whereas Child-Turcotte-Pugh performed better for acute decompensation patients.

Conclusion

MELD-Na score was superior to other liver-specific scores for predicting mortality in a cohort of cirrhotic patients admitted due to AOVH in a tertiary hospital.