Bedside risk-scoring model for predicting 6-week mortality in cirrhotic patients undergoing endoscopic band ligation for acute variceal bleeding
- Authors
- Kim, Jung Hee; Park, Se Woo; Jung, Jang Han; Park, Da Hae; Bang, Chang Seok; Park, Chan Hyuk; Park, Ji Won; Park, Jae Gun
- Issue Date
- Jul-2021
- Publisher
- WILEY
- Keywords
- Band ligation; Mortality; Risk; Score; Variceal bleeding
- Citation
- JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, v.36, no.7, pp.1935 - 1943
- Indexed
- SCIE
SCOPUS
- Journal Title
- JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY
- Volume
- 36
- Number
- 7
- Start Page
- 1935
- End Page
- 1943
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/1006
- DOI
- 10.1111/jgh.15426
- ISSN
- 0815-9319
- Abstract
- Background and Aim Acute variceal bleeding (AVB) is a fatal adverse event of cirrhosis, and endoscopic band ligation (EBL) is the standard treatment for AVB. We developed a novel bedside risk-scoring model to predict the 6-week mortality in cirrhotic patients undergoing EBL for AVB. Methods Cox regression analysis was used to assess the relationship of clinical, biological, and endoscopic variables with the 6-week mortality risk after EBL in a derivation cohort (n = 1373). The primary outcome was the predictive accuracy of the new model for the 6-week mortality in the validation cohort. Moreover, we tested the adequacy of the mortality risk-based stratification and the discriminative performance of our new model in comparison with the Child-Turcotte-Pugh (CTP) and the model for end-stage liver disease scores in the validation cohort (n = 200). Results On multivariate Cox regression analysis, five objective variables (use of beta-blockers, hepatocellular carcinoma, CTP class C, hypovolemic shock at initial presentation, and history of hepatic encephalopathy) were scored to generate a 12-point risk-prediction model. The model stratified the 6-week mortality risk in patients as low (3.5%), intermediate (21.1%), and high (53.4%) (P < 0.001). Time-dependent area under the receiver operating characteristic curve for 6-week mortality showed that this model was a better prognostic indicator than the CTP class alone in the derivation (P < 0.001) and validation (P < 0.001) cohorts. Conclusions A simplified scoring model with high potential for generalization refines the prediction of 6-week mortality in high-risk cirrhotic patients, thereby aiding the targeting and individualization of treatment strategies for decreasing the mortality rate.
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