Influencing factors of liver cirrhosis complicated with esophageal and gastric variceal bleeding and values of three models in predicting rebleeding

  Objective  To explore the influencing factors of liver cirrhosis complicated with esophageal and gastric variceal bleeding, and to evaluate values of the Serum Sodium Model for End-stage Liver Disease (MELD-Na), the Model for End-stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP) score in predicting rebleeding.

  Methods  Totally 196 liver cirrhosis patients with esophageal and gastric variceal bleeding were divided into bleeding group and non-bleeding group, and univariate and multivariate analyses were performed on the clinical indexes. The patients in the bleeding group were followed up, and values of three models in predicting rebleeding within half a year or one year after endoscopic treatment were evaluated.

  Results  Univariate analysis showed that there were significant differences in MELD-Na score, MELD score, CTP score, hepatic encephalopathy, red sign of varicose veins, hemoglobin, total bilirubin, creatinine, serum sodium and age between the bleeding group and the non-bleeding group (P < 0.05). Multivariate Logistic regression analysis showed that red sign, total bilirubin, concomitant hepatic encephalopathy, MELD score and CTP score were independent influencing factors of upper gastrointestinal bleeding in patients with esophageal and gastric varices. Receiver operating characteristic (ROC) curve analysis showed that the value of MELD-Na and MELD scores in predicting rebleeding within 6 months was significantly higher than that of CTP score (Z=2.162, 3.368, P=0.015, 0.001), and the value of MELD-Nascore in predicting rebleeding within a year was also significantly higher than that of CTP score(Z=2.407, P=0.008).

  Conclusion  CTP score, MELD score, red sign under gastroscope, hemoglobin, total bilirubin, creatinine, serum sodium and age are the risk factors of liver cirrhosis complicated with esophageal and gastric varices bleeding, while red sign under gastroscope, MELD score, CTP score, hepatic encephalopathy and total bilirubin are the independent risk factors of liver cirrhosis complicated with upper gastrointestinal bleeding. Among the three scoring systems, MELD-Na score shows the highest predictive value for rebleeding within 6 months or a year.