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2007, Number 3

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Rev Hosp Jua Mex 2007; 74 (3)

Utility of Meld, Child-Turcotte-Pugh and Rockall to predict mortality and rebleeding in cirrhotic patients with variceal hemorrhage

Altamirano-Gómez JT, Zapata-Irissón L, González-Angulo A, Ortiz-Salgado AL, Venegas-Sandoval J

Language: Spanish
References: 19
Page: 126-133
PDF size: 58.77 Kb.


ABSTRACT

Background. Variceal bleeding (VB) is a complication presented in 30% of the patients with terminal hepatic illness. The Child-Turcotte-Pugh scale (CTP) has demonstrated clinical utility to predict death in VB. The MELD score has been used to predict mortality in cirrhotic patients with VB and the change through the time of MELD (delta MELD) has been used to predict mortality in advanced cirrhotics. The scale of Rockall, used in patient with non variceal bleeding, has shown to be applicable in patient with VB. Objective. To evaluate the utility of MELD, CTP, Rockall and delta MELD to predict the in-patient mortality and recurrence of bleeding in cirrhotics with 1st. episode of VB. To analyze the variables associated with death in patients with VB. Material and methods. We analyzed retrospectively 69 patients, from January 2006 to March 2007. The utility of the scales for re-bleeding and mortality was evaluated by means of c-statistic, and the correlation by means of r of Pearson. The delta MELD was evaluated with the ROC curves and c-statistic. Univariate analysis was carried out with χ2. Results. The c-statistic for re-bleeding for MELD was of 0.62, CTP 0.61, scale of Rockall 0.43 and deltaMELD (› 2 pts) 0.63. The c-statistic for prediction of mortality was MELD 0.71, CTP 0.71, scale of Rockall 0.48 and deltaMELD (› 2) 0.57. Correlation of MELD › 16 with re-bleeding and death was r = 0.83 (p = ‹ 0.001) and r = 0.99 (p ‹ 0.001), respectively. The variables associated with death were: Albumin ‹ 2 .8gr/dL (p = 0.02), Na ‹ 135 mmol/L (p ‹ 0.01), encephalopathy › Grade 2 (p = 0.04) and ascites › Grade 2 (p = 0.02). Conclusions. The scales of MELD and CTP calculated at the entrance were similar to predict short term mortality, but superiors to the scale of Rockall. The utility of MELD for re-bleeding was the same of CTP. The deltaMELD (› 2) didn’t show clinical utility in re-bleeding and mortality.


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