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Adv Ther. 2019 Sep 11. doi: 10.1007/s12325-019-01083-5. [Epub ahead of print]

Development and Validation of CAGIB Score for Evaluating the Prognosis of Cirrhosis with Acute Gastrointestinal Bleeding: A Retrospective Multicenter Study.

Author information

1
Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), Shenyang, China.
2
Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China.
3
Liver Research Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
4
Department of Hepatobiliary Disease, 900 Hospital of the Joint Logistics Team (formerly called Fuzhou General Hospital), Fuzhou, China.
5
Department of Gastroenterology, First Affiliated Hospital of China Medical University, Shenyang, China.
6
Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.
7
Department of Critical Care Medicine, Sixth People's Hospital of Shenyang, Shenyang, China.
8
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
9
Department of Gastroenterology, General Hospital of Western Theater Command, Chengdu, China.
10
Department of Biological Therapy, Fifth Medical Center of PLA General Hospital, Beijing, China.
11
Difficult and Complicated Liver Diseases and Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, China.
12
Department of Gastroenterology, Xi'an Central Hospital, Xi'an, China.
13
Department of Gastroenterology, Air Force Hospital of Northern Theater Command, Shenyang, China.
14
Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), Shenyang, China. xingshunqi@126.com.

Abstract

INTRODUCTION:

Acute gastrointestinal bleeding (GIB) is a major cause of death in liver cirrhosis. This multicenter study aims to develop and validate a novel and easy-to-access model for predicting the prognosis of patients with cirrhosis and acute GIB.

METHODS:

Patients with cirrhosis and acute GIB were enrolled and randomly divided into the training (n = 865) and validation (n = 817) cohorts. In the training cohort, the independent predictors for in-hospital death were identified by logistic regression analyses, and then a new prognostic model (i.e., CAGIB score) was established. Area under curve (AUC) of CAGIB score was calculated by receiver operating characteristic curve analysis and compared with Child-Pugh, model for end-stage liver disease (MELD), MELD-Na, and neutrophil-lymphocyte ratio (NLR) scores.

RESULTS:

In the training cohort, hepatocellular carcinoma (HCC), diabetes, total bilirubin (TBIL), albumin (ALB), alanine aminotransferase (ALT), and serum creatinine (Scr) were independent predictors of in-hospital death. CAGIB score = diabetes (yes = 1, no = 0) × 1.040 + HCC (yes = 1, no = 0) × 0.974 + TBIL (μmol/L) × 0.005 - ALB (g/L) × 0.091 + ALT (U/L) × 0.001 + Scr (μmol/L) × 0.012 - 3.964. In the training cohort, the AUC of CAGIB score for predicting in-hospital death was 0.829 (95% CI 0.801-0.854, P < 0.0001), which was higher than that of Child-Pugh (0.762, 95% CI 0.732-0.791), MELD (0.778, 95% CI 0.748-0.806), MELD-Na (0.765, 95% CI 0.735-0.793), and NLR (0.587, 95% CI 0.553-0.620) scores. In the validation cohort, the AUC of CAGIB score (0.714, 95% CI 0.682-0.746, P = 0.0006) remained higher than that of Child-Pugh (0.693, 95% CI 0.659-0.725), MELD (0.662, 95% CI 0.627-0.695), MELD-Na (0.660, 95% CI 0.626-0.694), and NLR (0.538, 95% CI 0.503-0.574) scores.

CONCLUSION:

CAGIB score has a good predictive performance for prognosis of patients with cirrhosis and acute GIB.

KEYWORDS:

Child–Pugh; Cirrhosis; Gastrointestinal bleeding; MELD; Prognosis

PMID:
31512140
DOI:
10.1007/s12325-019-01083-5

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