Evaluation of the MELNa AGIB Scale to Predict Mortality in Patients with Cirrhosis and Variceal Hemorrhage.
Introduction and Objectives: Patients with decompensated cirrhosis are at risk of variceal hemorrhage, which increases the risk of mortality. Validated scales exist to assess this risk, but there is currently no scale that evaluates the risk of variceal hemorrhage and death simultaneously. The MELDN...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-02-01
|
| Series: | Annals of Hepatology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1665268124002394 |
| _version_ | 1797272522891198464 |
|---|---|
| author | Miguel Y. Carmona-Castillo María F. Higuera-de la Tijera Sandra Teutli-Carrion Ernesto J. Medina-Avalos Claudia L. Dorantes-Nava José L. Pérez-Hernández |
| author_facet | Miguel Y. Carmona-Castillo María F. Higuera-de la Tijera Sandra Teutli-Carrion Ernesto J. Medina-Avalos Claudia L. Dorantes-Nava José L. Pérez-Hernández |
| author_sort | Miguel Y. Carmona-Castillo |
| collection | DOAJ |
| description | Introduction and Objectives: Patients with decompensated cirrhosis are at risk of variceal hemorrhage, which increases the risk of mortality. Validated scales exist to assess this risk, but there is currently no scale that evaluates the risk of variceal hemorrhage and death simultaneously. The MELDNa AGIB (acute gastrointestinal bleeding) scale incorporates sodium (Na) levels, albumin levels, the corrected QT interval (QTc), and a history of hemorrhage to calculate mortality at 6 weeks. While it has been evaluated in other centers, further studies are needed to validate its utility. To evaluate the MELDNa-AGIB scale for predicting the risk of mortality in decompensated cirrhotic patients. Materials and Patients: This was a retrospective, analytical, observational study conducted on a cohort of patients with decompensated cirrhosis and variceal hemorrhage. The MELDNAAGIB scale was calculated for each patient and compared with other scoring systems, including MELD, MELD NA, MELD LACTATE, and MELD 3.0, to assess its effectiveness. Statistical analysis involved the construction of ROC curves to determine the prognostic value of each scoring system in predicting mortality among patients with variceal bleeding. A significance level of p<0.05 was considered, and sensitivity and specificity were determined based on the cutoff points obtained from the significant ROC curves. Results: A total of 32 patients were included in the study, of whom 56.2% were male, with an average age of 57±11. The etiologies of cirrhosis included alcohol-related, metabolic-associated fatty liver disease (MAFLD), dual injury, hepatitis C virus (HCV), autoimmune hepatitis (AIH), and unidentified causes (34.37%, 31.25%, 21.87%, 6.25%, 3.12%, 3.12%, respectively). Fifty percent of the patients had a prolonged QTc interval (>456ms) as calculated using the Fridericia formula, and 67.2% had a history of previous variceal hemorrhage. The MELDNa-AGIB scale demonstrated an area under the receiver operating characteristic (AUROC) curve of 0.849 (95% confidence interval: 0.681-0.950, p=0.004), with a sensitivity of 87.5% and specificity of 83% when a cutoff point of 17 was applied for MELDNa-AGIB. The AUROC for predicting mortality was significantly lower for MELD/Lactate. Conclusions: Although the study group was small, the MELDNaAGIB scale showed significant performance in predicting 6-week mortality in patients who developed variceal hemorrhage. |
| first_indexed | 2024-03-07T14:30:33Z |
| format | Article |
| id | doaj.art-f0d1f6bd39c64e52a4b1709d31b43b8c |
| institution | Directory Open Access Journal |
| issn | 1665-2681 |
| language | English |
| last_indexed | 2024-03-07T14:30:33Z |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Hepatology |
| spelling | doaj.art-f0d1f6bd39c64e52a4b1709d31b43b8c2024-03-06T05:26:12ZengElsevierAnnals of Hepatology1665-26812024-02-0129101445Evaluation of the MELNa AGIB Scale to Predict Mortality in Patients with Cirrhosis and Variceal Hemorrhage.Miguel Y. Carmona-Castillo0María F. Higuera-de la Tijera1Sandra Teutli-Carrion2Ernesto J. Medina-Avalos3Claudia L. Dorantes-Nava4José L. Pérez-Hernández5Gastroenterology and Hepatology Service, General Hospital of México “Dr. Eduardo Liceaga”, Mexico City, MexicoGastroenterology and Hepatology Service, General Hospital of México “Dr. Eduardo Liceaga”, Mexico City, MexicoGastroenterology and Hepatology Service, General Hospital of México “Dr. Eduardo Liceaga”, Mexico City, MexicoGastroenterology and Hepatology Service, General Hospital of México “Dr. Eduardo Liceaga”, Mexico City, MexicoGastroenterology and Hepatology Service, General Hospital of México “Dr. Eduardo Liceaga”, Mexico City, MexicoGastroenterology and Hepatology Service, General Hospital of México “Dr. Eduardo Liceaga”, Mexico City, MexicoIntroduction and Objectives: Patients with decompensated cirrhosis are at risk of variceal hemorrhage, which increases the risk of mortality. Validated scales exist to assess this risk, but there is currently no scale that evaluates the risk of variceal hemorrhage and death simultaneously. The MELDNa AGIB (acute gastrointestinal bleeding) scale incorporates sodium (Na) levels, albumin levels, the corrected QT interval (QTc), and a history of hemorrhage to calculate mortality at 6 weeks. While it has been evaluated in other centers, further studies are needed to validate its utility. To evaluate the MELDNa-AGIB scale for predicting the risk of mortality in decompensated cirrhotic patients. Materials and Patients: This was a retrospective, analytical, observational study conducted on a cohort of patients with decompensated cirrhosis and variceal hemorrhage. The MELDNAAGIB scale was calculated for each patient and compared with other scoring systems, including MELD, MELD NA, MELD LACTATE, and MELD 3.0, to assess its effectiveness. Statistical analysis involved the construction of ROC curves to determine the prognostic value of each scoring system in predicting mortality among patients with variceal bleeding. A significance level of p<0.05 was considered, and sensitivity and specificity were determined based on the cutoff points obtained from the significant ROC curves. Results: A total of 32 patients were included in the study, of whom 56.2% were male, with an average age of 57±11. The etiologies of cirrhosis included alcohol-related, metabolic-associated fatty liver disease (MAFLD), dual injury, hepatitis C virus (HCV), autoimmune hepatitis (AIH), and unidentified causes (34.37%, 31.25%, 21.87%, 6.25%, 3.12%, 3.12%, respectively). Fifty percent of the patients had a prolonged QTc interval (>456ms) as calculated using the Fridericia formula, and 67.2% had a history of previous variceal hemorrhage. The MELDNa-AGIB scale demonstrated an area under the receiver operating characteristic (AUROC) curve of 0.849 (95% confidence interval: 0.681-0.950, p=0.004), with a sensitivity of 87.5% and specificity of 83% when a cutoff point of 17 was applied for MELDNa-AGIB. The AUROC for predicting mortality was significantly lower for MELD/Lactate. Conclusions: Although the study group was small, the MELDNaAGIB scale showed significant performance in predicting 6-week mortality in patients who developed variceal hemorrhage.http://www.sciencedirect.com/science/article/pii/S1665268124002394 |
| spellingShingle | Miguel Y. Carmona-Castillo María F. Higuera-de la Tijera Sandra Teutli-Carrion Ernesto J. Medina-Avalos Claudia L. Dorantes-Nava José L. Pérez-Hernández Evaluation of the MELNa AGIB Scale to Predict Mortality in Patients with Cirrhosis and Variceal Hemorrhage. Annals of Hepatology |
| title | Evaluation of the MELNa AGIB Scale to Predict Mortality in Patients with Cirrhosis and Variceal Hemorrhage. |
| title_full | Evaluation of the MELNa AGIB Scale to Predict Mortality in Patients with Cirrhosis and Variceal Hemorrhage. |
| title_fullStr | Evaluation of the MELNa AGIB Scale to Predict Mortality in Patients with Cirrhosis and Variceal Hemorrhage. |
| title_full_unstemmed | Evaluation of the MELNa AGIB Scale to Predict Mortality in Patients with Cirrhosis and Variceal Hemorrhage. |
| title_short | Evaluation of the MELNa AGIB Scale to Predict Mortality in Patients with Cirrhosis and Variceal Hemorrhage. |
| title_sort | evaluation of the melna agib scale to predict mortality in patients with cirrhosis and variceal hemorrhage |
| url | http://www.sciencedirect.com/science/article/pii/S1665268124002394 |
| work_keys_str_mv | AT miguelycarmonacastillo evaluationofthemelnaagibscaletopredictmortalityinpatientswithcirrhosisandvaricealhemorrhage AT mariafhigueradelatijera evaluationofthemelnaagibscaletopredictmortalityinpatientswithcirrhosisandvaricealhemorrhage AT sandrateutlicarrion evaluationofthemelnaagibscaletopredictmortalityinpatientswithcirrhosisandvaricealhemorrhage AT ernestojmedinaavalos evaluationofthemelnaagibscaletopredictmortalityinpatientswithcirrhosisandvaricealhemorrhage AT claudialdorantesnava evaluationofthemelnaagibscaletopredictmortalityinpatientswithcirrhosisandvaricealhemorrhage AT joselperezhernandez evaluationofthemelnaagibscaletopredictmortalityinpatientswithcirrhosisandvaricealhemorrhage |