Upper gastrointestinal (GI) bleeding from esophageal or gastric fundus varices is a common complication of portal hypertension in liver cirrhosis.
It carries a high mortality rate of 20% to 35%.
Stratifying high-risk patients for variceal bleeding is mainly based on endoscopic scoring.
Dr Frank Tacke and colleagues from Germany developed a simple clinical score to assess the bleeding risk in patients with chronic liver disease.
|22% developed upper GI hemorrhages from varices|
|Scandinavian Journal of Gastroenterology|
The research team identified 111 patients with chronic liver diseases for potential liver transplantation, with a follow-up of 6 years.
The team analyzed findings at study entry for their value in predicting hemorrhages.
The researchers found that 22% of patients developed upper gastrointestinal hemorrhages from varices during the follow-up period.
Common characteristics at study entry of patients with future bleedings included viral hepatitis or alcoholic etiology.
The team noted that advanced-stage cirrhosis, and decreased liver function were other characteristics at study entry.
Patients also presented with impaired hemostasis, and endoscopic presence of varices at study entry.
The research team found that these parameters were independent predictors of bleedings.
A 4-item Bleeding Risk Score was used to identify patients at high or low risk of bleedings.
The score included cholinesterase less than 2 kU/l, and an international normalized ratio higher than 1.2.
Viral or alcoholic etiology, and presence of varices was also included in the score.
The researchers found that the score was superior in sensitivity and specificity to the Child-Pugh or mucosa associated lymphoid tissue score.
Dr Tacke's team concluded, “A simple clinical score can predict the risk for upper gastrointestinal bleedings in patients with chronic liver disease.”
“This Bleeding Risk Score may help to supplement current endoscopic and clinical approaches to identify high-risk patients.”