Abstract:
BACKGROUND:Acute variceal bleeding (AVB) in patients with cirrhosis is associated with high mortality, ranging from 12 to 20% at 6 weeks. The existing prognostic models for AVB lack precision and require further validation. AIM:In this prospective study, we aimed to develop and validate a new prognostic model for AVB, and compared it with the existing models. METHODS:We included 285 patients from March 2017 to November 2017 in the derivation cohort and 238 patients from December 2017 to June 2018 in the validation cohort. Two prognostic models were developed from derivation cohort by logistic regression analysis. Discrimination was assessed using area under the receiver operator characteristic curve (AUROC). RESULTS:The 6-week mortality was 22.1% in derivation cohort and 22.3% in validation cohort, P = 0.866. Model for end-stage liver disease (MELD) [odds ratio (OR) 1.106] and encephalopathy (E) (OR 4.658) in one analysis and Child-Pugh score (OR 1.379) and serum creatinine (OR 1.474) in another analysis were significantly associated with 6-week mortality. MELD-E model (AUROC 0.792) was superior to Child-creatinine model (AUROC) in terms of discrimination. The MELD-E model had highest AUROC; as compared to other models-MELD score (AUROC 0.751, P = 0.036), Child-Pugh score (AUROC 0.737, P = 0.037), D'Amico model (AUROC 0.716, P = 0.014) and Augustin model (AUROC 0.739, P = 0.018) in derivation cohort. In validation cohort, the discriminatory performance of MELD-E model (AUROC 0.805) was higher as compared to other models including MELD score (AUROC 0.771, P = 0.048), Child-Pugh score (AUROC 0.746, P = 0.011), Augustin model (AUROC 0.753, P = 0.039) and D'Amico model (AUROC 0.736, P = 0.021). CONCLUSION:In cirrhotic patients with AVB, the novel MELD-Encephalopathy model predicts 6 weeks mortality with higher accuracy than the existing prognostic models.
journal_name
Dig Dis Scijournal_title
Digestive diseases and sciencesauthors
Rout G,Sharma S,Gunjan D,Kedia S,Saraya A,Nayak B,Singh V,Kumar R,Shalimardoi
10.1007/s10620-019-05557-ysubject
Has Abstractpub_date
2019-08-01 00:00:00pages
2327-2337issue
8eissn
0163-2116issn
1573-2568pii
10.1007/s10620-019-05557-yjournal_volume
64pub_type
杂志文章abstract::Maintenance of intragastric pH > 4 is vital for effective management of gastroesophageal reflux disease (GERD). Esomeprazole 40 mg, the first proton pump inhibitor developed as an optical isomer, demonstrates improved acid inhibition over omeprazole 20 mg. Our aim was to compare esomeprazole 40 mg with omeprazole 40 m...
journal_title:Digestive diseases and sciences
pub_type: 临床试验,杂志文章,随机对照试验
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abstract::Although ethanol has been reported to inhibit intestinal amino acid absorption and peptide hydrolysis by the brush border membrane (BBM) peptidases, its effect on other events of protein absorption (such as peptide hydrolysis by cytosol peptidases, absorption of peptides across the BBM, and translocation of amino acid...
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abstract::Our purpose is to focus attention on the cancer family history, coupled with an understanding of the natural history and extracolonic tumor spectrum of familial adenomatous polyposis (FAP), through a family study. This family report provides an example of how colorectal cancer (CRC) can be prevented by knowledgeable g...
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pub_type: 杂志文章,随机对照试验
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journal_title:Digestive diseases and sciences
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journal_title:Digestive diseases and sciences
pub_type: 临床试验,杂志文章
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pub_type: 临床试验,杂志文章,多中心研究
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