Clinical value of 4 scoring systems in evaluating the short-term prognosis of patients suffering from HBV-ACLF complicated with esophageal gastric variceal bleeding

Abstract

Abstract: Objective To investigate the clinical value of liver stiffness-spleen diameter-to-platelet ratio score (LSPS), albumin-bilirubin scoring model (ALBI), model for end-stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) in evaluating short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) and esophagealgastric variceal bleeding (EGVB).Methods Fifty-two patients with HBV-ACLF and EGVB admitted to our hospital from December 18, 2018 to September 6, 2021 were collected. According to 28-day prognosis, they were divided into survival group (35 cases) and death group (17 cases). The clinical data of patients were analyzed and the scores of the 4 scoring systems were calculated. The efficacy of the 4 scoring systems in predicting the 28-day and 90-day mortality was evaluated by receiver operating characteristic (ROC) curve.Results Compared with survival group, patients in death group had higher total bilirubin (TBIL) level [395.6(97.9, 562.9) vs 211.9(41.7, 422.6) umol/L], portal vein diameter [13(12.5, 14) vs 12(10, 13) mm] and spleen diameter [13.2(11.9, 16.1) vs 11.8(11, 12.05) cm]. The incidence rates of hepatic encephalopathy (94.1% vs 11.4%), hepatorenal syndrome (100.0% vs 57.1%) and infections (100.0% vs 65.7%) (P<0.05) in the death group were significantly higher. The scores of ALBI [-2.3(-2.69, -1.87) vs (-2.7(-3.01, -2.37))], MELD [18.94(11.8, 38.6) vs 12.47(4.64, 22.58)] and CTP [14(13, 14.5) vs 11(9, 12)] of death group were significantly also higher. ROC curve analysis of the 28-day death risk showed that the area under the curve (AUC) of LSPS, ALBI, MELD and CTP scores were 0.533, 0.620, 0.664 and 0.848, suggesting the CTP scoring system was superior to the other three ( P<0.05) in predicting the 28-day mortality. ROC curve analysis of the 90-day death risk showed that the AUC of LSPS, ALBI, MELD and CTP scores were 0.633, 0.586, 0.656 and 0.805, suggesting the CTP scoring system performed better in predicting the 90-day mortality ( P<0.05).Conclusion CTP scoring system performs better in predicting the short-term prognosis of patients with HBV-ACLF and EGVB.

Key words: Hepatitis B virus-related acute on chronic liver failure, Esophageal and gastric variceal bleeding, Child-Turcotte-Pugh score, Short-term prognosis

WANG Ai-min, MEI Xue, GUO Hong-ying , YUAN Wei, ZHANG Yu-yi, QIAN Zhi-ping, WANG Jie-fei, LIU Yu. Clinical value of 4 scoring systems in evaluating the short-term prognosis of patients suffering from HBV-ACLF complicated with esophageal gastric variceal bleeding[J]. Chinese Hepatolgy, 2022, 27(4): 421-425.

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