Prognosis of the clinical course of portal hypertension complicated by the acute variceal bleeding

Abstract

Annotation. Variceal bleeding is one of the most dangerous complications of liver cirrhosis, which is associated with relatively high lethality. At the same time, the bleeding can trigger some other complications of liver cirrhosis that further worsen the prognosis for these patients. These factors determine the necessity not only for the diagnosis of variceal bleeding in patients with liver cirrhosis but also for the prognosis of possible recurrent bleeding and lethality. The aim of this study was to evaluate the possibility of predicting survival or lethality in patients with variceal bleeding. This study is based on the results of the investigation and treatment of 121 patients with liver cirrhosis complicated by variceal bleeding. To determine the prognostic value of the clinical course, the analysis of various markers of complete blood count, biochemical blood and coagulation markers, Child-Turcotte-Pugh and MELD criteria was performed. The ROC (receiver operating characteristic) curve was applied for the evaluation and comparison of various markers. Additionally, the specificity, sensitivity, accuracy, positive (PPV) and negative prognostic value (NPV), positive (LR+) and negative (LR-) likelihood ratio were used. The J-index (index Youden) was applied for the comparison of border values. Predicting the clinical course allows for identifying patients with a possible unfavorable prognosis who require intensive therapy, as well as those with minimal risk of fatal outcome. According to the study results, the International normalized ratio (sensitivity – 95%, specificity – 97%), potassium blood level (sensitivity – 95.2%, specificity – 89%), and MELD score (sensitivity – 95.2%, specificity – 86%) are the markers, which had the highest prognostic value for the unfavorable clinical course. Whereas the sodium blood level (sensitivity – 96%, specificity – 100%) was the best marker of favorable clinical course. Other analyzed indicators had limited prognostic significance. Thus, although the number of bleedings in the anamnesis increases the risk of a fatal outcome, it has limited importance for prognostics of a favorable or unfavorable course of variceal bleeding. The sodium blood level is the best marker for the prediction of a favorable clinical course. International normalized ratio, potassium blood level, and MELD score are the markers of an unfavorable clinical course.