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News

Model determines risk of mortality among patients with acute variceal bleeding

A study in the latest issue of Gastroenterology develops a MELD-based model to determine risk of mortality among patients with acute variceal bleeding. 

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Patients with cirrhosis with acute variceal bleeding have high mortality rates.

Previously described models are seldom used to determine prognoses of these patients, partially because they have not been validated externally and because they include subjective variables, such as bleeding during endoscopy and Child–Pugh score, which are evaluated inconsistently.

Dr Juan Abraldes and colleagues from Canada improved determination of risk for patients with acute variceal bleeding.

The researchers analyzed data collected from 178 patients with cirrhosis and esophageal acute variceal bleeding who received standard therapy from 2007 through 2010.

The team tested the performance of previously described models, including the model for end-stage liver disease (MELD), and developed a new MELD calibration to predict the mortality of patients within 6 weeks of presentation with acute variceal bleeding.

MELD-based predictions were validated in cohorts of patients from Canada and Spain.

The 6-week mortality rate was 16%
Gastroenterology

Among study subjects, the team found that the 6-week mortality rate was 16%.

MELD was the best model in terms of discrimination, and it was recalibrated to predict the 6-week mortality rate with logistic regression.

The research team reported that MELD values of 19 or greater predicted 20% or greater mortality, whereas MELD scores less than 11 predicted less than 5% mortality.

The model performed well for patients from Canada at all risk levels.

In the Spanish validation set, in which all patients were treated with banding ligation, MELD predictions were accurate up to the 20% risk threshold.

Dr Abraldes' team comments, "We developed a MELD-based model that accurately predicts mortality among patients with acute variceal bleeding, based on objective variables available at admission."

"This model could be useful to evaluate the efficacy of new therapies and stratify patients in randomized trials."

Gastroenterology 2014: 146(2): 412-419.e3
05 February 2014

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