A clinical prediction model and its application for bleeding in chronic liver failure patients with esophageal varices

X. Wang, B.-M. Wang, G. Li, Z.-J. Li, C. Chen, M.-Y. Piao

Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China. bangm56mao@163.com

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• Gastroenterology

OBJECTIVES: We aimed to explore the model for end-stage liver disease (MELD), Child-Turcotte-Pugh (CTP) score, endotoxin, bleeding score and dynamic changes of D-dimer in chronic liver failure patients with portal hypertension and esophageal varices, and explored their potential contact with bleeding in short-term prognosis.

PATIENTS AND METHODS: Chronic liver failure patients with esophageal varices were divided into 2 groups: bleeding group (Group A, n=50) and non-bleeding group (Group B, n=50). MELD, CTP score, endotoxin and plasma D-dimer was compared at different time point. The receiver operating characteristic curve (ROC) was drawn. The predictive model based on their cut off value in esophageal varices bleeding patients was evaluated.

RESULTS: Infection and endotoxin levels were related with bleeding and death in chronic liver failure patients with esophageal varices, and affect the patient’s coagulation and fibrinolysis activity. The criteria of predictive model for predicting hemorrhage of esophageal varices in patients with chronic liver failure is: MELD ≥ 26; bleeding grading score ≥ 10; and/or plasma D-dimer > 700 ug/L. Plasma D-dimer, MELD score and death rate showed significant differences between two groups. Patients with chronic liver failure occurred bleeding and eventually dead have persistent anomaly plasma D-dimer level. In our model-group patients, the D-dimer and CTP score has statistical difference between surviving and death patients (p < 0.05).

CONCLUSIONS: This model could predict the prognosis of bleeding in chronic liver failure patients with esophageal varices. And has the short-term prognostic value for clinical application.

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