Skip to main content

Prognostic Assessment of Variceal Bleeding in Liver Cirrhosis

  • Chapter
  • First Online:
  • 420 Accesses

Abstract

Acute variceal bleeding (AVB) is one of the most common complications of liver cirrhosis with a high morbidity and mortality. Despite the improved management strategy, the mortality of patients with AVB is still very high. An adequate selection of high-risk patients could help to optimize the management strategy and further improve the outcomes. Many prognostic assessment methods of AVB in cirrhotic patients have been identified. In the present chapter, we briefly reviewed the prognostic assessment of AVB in patients with liver cirrhosis.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. De Franchis R. Portal hypertension VI: proceedings of the sixth Baveno consensus workshop: stratifying risk and individualizing care: Springer; 2015.

    Google Scholar 

  2. Garcia-Tsao G, Bosch J. Management of varices and variceal hemorrhage in cirrhosis. N Engl J Med. 2010;362(9):823–32.

    Article  CAS  PubMed  Google Scholar 

  3. Abraldes JG, Bosch J. The treatment of acute variceal bleeding. J Clin Gastroenterol. 2007;41(Suppl 3):S312–7.

    Article  PubMed  Google Scholar 

  4. de Franchis R, Baveno VIF. Expanding consensus in portal hypertension: report of the Baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63(3):743–52.

    Article  PubMed  Google Scholar 

  5. Singal AK, Jampana SC, Singal V, Kuo YF. Hepatocellular carcinoma predicts in-hospital mortality from acute variceal hemorrhage among patients with cirrhosis. J Clin Gastroenterol. 2012;46(7):613–9.

    Article  PubMed  Google Scholar 

  6. Bambha K, Kim WR, Pedersen R, Bida JP, Kremers WK, Kamath PS. Predictors of early re-bleeding and mortality after acute variceal haemorrhage in patients with cirrhosis. Gut. 2008;57(6):814–20.

    Article  CAS  PubMed  Google Scholar 

  7. Ibrahim M, Mostafa I, Deviere J. New developments in managing Variceal bleeding. Gastroenterology. 2018;154(7):1964–9.

    Article  PubMed  Google Scholar 

  8. Garcia-Pagan JC, Di Pascoli M, Caca K, Laleman W, Bureau C, Appenrodt B, et al. Use of early-TIPS for high-risk variceal bleeding: results of a post-RCT surveillance study. J Hepatol. 2013;58(1):45–50.

    Article  PubMed  Google Scholar 

  9. Lv Y, Zuo L, Zhu X, Zhao J, Xue H, Jiang Z, et al. Identifying optimal candidates for early TIPS among patients with cirrhosis and acute variceal bleeding: a multicentre observational study. Gut. 2019;68(7):1297–310.

    Article  CAS  PubMed  Google Scholar 

  10. Peng Y, Qi X, Tang S, Deng H, Li J, Ning Z, et al. Child-Pugh, MELD, and ALBI scores for predicting the in-hospital mortality in cirrhotic patients with acute-on-chronic liver failure. Expert Rev Gastroenterol Hepatol. 2016;10(8):971–80.

    CAS  PubMed  Google Scholar 

  11. Peng Y, Qi X, Dai J, Li H, Guo X. Child-Pugh versus MELD score for predicting the in-hospital mortality of acute upper gastrointestinal bleeding in liver cirrhosis. Int J Clin Exp Med. 2015;8(1):751–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Peng Y, Qi X, Guo X. Child-Pugh versus MELD score for the assessment of prognosis in liver cirrhosis: a systematic review and meta-analysis of observational studies. Medicine (Baltimore). 2016;95(8):e2877.

    Article  Google Scholar 

  13. Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31(4):864–71.

    Article  CAS  PubMed  Google Scholar 

  14. Flores-Rendon AR, Gonzalez-Gonzalez JA, Garcia-Compean D, Maldonado-Garza HJ, Garza-Galindo AA. Model for end stage of liver disease (MELD) is better than the Child-Pugh score for predicting in-hospital mortality related to esophageal variceal bleeding. Ann Hepatol. 2008;7(3):230–4.

    Article  PubMed  Google Scholar 

  15. Durand F, Valla D. Assessment of the prognosis of cirrhosis: Child-Pugh versus MELD. J Hepatol. 2005;42(Suppl(1)):S100–7.

    Article  PubMed  Google Scholar 

  16. Biggins SW, Kim WR, Terrault NA, Saab S, Balan V, Schiano T, et al. Evidence-based incorporation of serum sodium concentration into MELD. Gastroenterology. 2006;130(6):1652–60.

    Article  PubMed  Google Scholar 

  17. Wang R, Guo X, Fernando GR, Qi X. The optimal imaging diagnostic method of sarcopenia in liver transplantation: an unresolved issue. AME Med J. 2018;2:47.

    Google Scholar 

  18. Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359(10):1018–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Wang J, Wang AJ, Li BM, Liu ZJ, Chen L, Wang H, et al. MELD-Na: effective in predicting rebleeding in cirrhosis after cessation of esophageal variceal hemorrhage by endoscopic therapy. J Clin Gastroenterol. 2014;48(10):870–7.

    Article  PubMed  Google Scholar 

  20. Rout G, Sharma S, Gunjan D, Kedia S, Saraya A, Nayak B, et al. Development and validation of a novel model for outcomes in patients with cirrhosis and acute variceal bleeding. Dig Dis Sci. 2019;64(8):2327–37.

    Google Scholar 

  21. Cerqueira RM, Andrade L, Correia MR, Fernandes CD, Manso MC. Risk factors for in-hospital mortality in cirrhotic patients with oesophageal variceal bleeding. Eur J Gastroenterol Hepatol. 2012;24(5):551–7.

    Article  PubMed  Google Scholar 

  22. Child CG, Turcotte JG. The liver and portal hypertension. Philadelphia: MPCS. WB Saunders; 1964.

    Google Scholar 

  23. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646–9.

    Article  CAS  PubMed  Google Scholar 

  24. Chalasani N, Kahi C, Francois F, Pinto A, Marathe A, Bini EJ, et al. Model for end-stage liver disease (MELD) for predicting mortality in patients with acute variceal bleeding. Hepatology. 2002;35(5):1282–4.

    Article  PubMed  Google Scholar 

  25. Saltzman JR, Tabak YP, Hyett BH, Sun X, Travis AC, Johannes RS. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc. 2011;74(6):1215–24.

    Article  PubMed  Google Scholar 

  26. Wang F, Cui S, Wang F, Li F, Tang F, Zhang X, et al. Different scoring systems to predict 6-week mortality in cirrhosis patients with acute variceal bleeding: a retrospective analysis of 202 patients. Scand J Gastroenterol. 2018;53(7):885–90.

    Article  PubMed  Google Scholar 

  27. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for uppergastrointestinal haemorrhage. Lancet. 2000;356(9238):1318–21.

    Article  CAS  PubMed  Google Scholar 

  28. Iino C, Shimoyama T, Igarashi T, Aihara T, Ishii K, Sakamoto J, et al. Usefulness of the Glasgow-Blatchford score to predict 1-week mortality in patients with esophageal variceal bleeding. Eur J Gastroenterol Hepatol. 2017;29(5):547–51.

    Article  PubMed  Google Scholar 

  29. Lee HH, Park JM, Han S, Park SM, Kim HY, Oh JH, et al. A simplified prognostic model to predict mortality in patients with acute variceal bleeding. Dig Liver Dis. 2018;50(3):247–53.

    Article  PubMed  Google Scholar 

  30. D’Amico G, Pasta L, Morabito A, D’Amico M, Caltagirone M, Malizia G, et al. Competing risks and prognostic stages of cirrhosis: a 25-year inception cohort study of 494 patients. Aliment Pharmacol Ther. 2014;39(10):1180–93.

    Article  PubMed  Google Scholar 

  31. Li Y, Han B, Li H, Song T, Bao W, Wang R, et al. Effect of admission time on the outcomes of liver cirrhosis with acute upper gastrointestinal bleeding: regular hours versus off-hours admission. Can J Gastroenterol Hepatol. 2018;2018:3541365.

    PubMed  PubMed Central  Google Scholar 

  32. Johnson PJ, Berhane S, Kagebayashi C, Satomura S, Teng M, Reeves HL, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol. 2015;33(6):550–8.

    Article  PubMed  Google Scholar 

  33. Zou D, Qi X, Zhu C, Ning Z, Hou F, Zhao J, et al. Albumin-bilirubin score for predicting the in-hospital mortality of acute upper gastrointestinal bleeding in liver cirrhosis: a retrospective study. Turk J Gastroenterol. 2016;27(2):180–6.

    Article  PubMed  Google Scholar 

  34. Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol. 2013;88(1):218–30.

    Article  PubMed  Google Scholar 

  35. Qi X, Li J, Deng H, Li H, Su C, Guo X. Neutrophil-to-lymphocyte ratio for the prognostic assessment of hepatocellular carcinoma: a systematic review and meta-analysis of observational studies. Oncotarget. 2016;7(29):45283–301.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Peng Z, He Z, Guo X, Tacke F, Yang S-S, Sugawara Y, et al. Neutrophil to lymphocyte ratio and albumin-bilirubin score for predicting the in-hospital mortality of hepatocellular carcinoma with acute upper gastrointestinal bleeding. J AME Med J. 2017;2(11)

    Google Scholar 

  37. Bai Z, Li B, Lin S, Liu B, Li Y, Zhu Q, et al. Development and validation of CAGIB score for evaluating the prognosis of cirrhosis with acute gastrointestinal bleeding: a retrospective multicenter study. Adv Ther. 2019;36(11):3211–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Gao F, Wang R, Deng H, Hou F, Romeiro FG, Qi X. Liver-to-abdominal area ratio for predicting the in-hospital mortality in advanced liver cirrhosis. Postgrad Med. 2017;129(7):756–61.

    Article  PubMed  Google Scholar 

  39. Deng H, Qi X, Zhang Y, Peng Y, Li J, Guo X. Diagnostic accuracy of contrast-enhanced computed tomography for esophageal varices in liver cirrhosis: a retrospective observational study. J Evid Based Med. 2017;10(1):46–52.

    Article  PubMed  Google Scholar 

  40. Li Q, Wang R, Guo X, Li H, Shao X, Zheng K, et al. Contrast-enhanced CT may be a diagnostic alternative for gastroesophageal varices in cirrhosis with and without previous endoscopic variceal therapy. Gastroenterol Res Pract. 2019;2019:6704673.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Wang, R., Silva-Junior, G., Guo, X., Qi, X. (2021). Prognostic Assessment of Variceal Bleeding in Liver Cirrhosis. In: Guo, X., Qi, X. (eds) Variceal Bleeding in Liver Cirrhosis. Springer, Singapore. https://doi.org/10.1007/978-981-15-7249-4_10

Download citation

  • DOI: https://doi.org/10.1007/978-981-15-7249-4_10

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-7248-7

  • Online ISBN: 978-981-15-7249-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics