Introduction
Gastrointestinal (GI) hemorrhage accounts for 30% of acute decompensations in cirrhotic patients, with 60% originating from variceal bleeding. Each decompensation episode carries an in-hospital mortality rate of 13%, and a 6-week mortality rate of 20%, commonly assed using Child Pugh (CP) and MELD scores. The ALBI (Albumin-Bilirubin) score, which includes only two variables, offers a simplified evaluation of liver function. However, there is limited data on its utility in predicting short-term mortality in cirrhotic patients with GI hemorrhage.
Aims & Methods
This study aimed to evaluate the association between ALBI Score with short-term mortality in cirrhotic patients with GI hemorrhage. We conducted a prospective, cross-sectional study between January and December of 2023 at Hospital Roosevelt, Guatemala, including cirrhotic patients admitted for GI hemorrhage. Informed consent was obtained from all participants. Categorical variables were analyzed using the chi-square test, normally distributed continuous variables with Student’s t-test, and non-normally distributed variables with the Mann-Whitney U test. Logistic binary regression and AUROC analysis were used to assess associations with short-term mortality. Statistical analyses were performed using SPSS.
Results
A total of 187 patients were included: 50.8% female and 49.2% male, with a mean age of 56 among survivors and 58 among non-survivors. Of these, 52.9% had a prior diagnosis of cirrhosis, while 47.1% were newly diagnosed. Cirrhosis etiology was metabolic in 50.2%, alcoholic in 42.7%, autoimmune in 4.3%, HCV in 1.6%, and HBV in 1.1%. At admission, 80.8% had no ascites and 97.3% had no hepatic encephalopathy. he causes of GI hemorrhage were 86.1% esophageal varices, 3.2% gastric varices, 9.1% gastric ulcers, and 1.6% esophagitis.
Non-survivors had significantly lower systolic blood pressure (93.90 ± 16.3 mmHg vs. 107.92 ± 17.4 mmHg; p = 0.002) and mean arterial pressure (69.50 ± 14.5 mmHg vs. 79.67 ± 11.7 mmHg; p = 0.005) compared to survivors. Non-survivors exhibited significantly higher INR (1.79 ± 0.56 vs. 1.52 ± 0.41; p = 0.026) and total bilirubin (5.85 ± 8.73 mg/dL vs. 2.02 ± 2.82 mg/dL; p = 0.031), and lower serum albumin levels (2.40 ± 0.43 g/dL vs. 3.10 ± 0.54 g/dL; p < 0.001).
Prognostic scores were significantly higher among non-survivors: MELD (19.25 ± 10.09 vs. 13.57 ± 5.47; p = 0.002), MELD-Na (20.35 ± 9.76 vs. 14.44 ± 6.42; p = 0.002), Child-Pugh (9.15 ± 2.21 vs. 7.18 ± 1.90; p < 0.001), and ALBI score (-0.96 ± 0.51 vs. -1.76 ± 0.58; p < 0.001). Additionally, the length of hospital stay was significantly shorter among non-survivors (3.90 ± 3.82 days) compared to survivors (6.59 ± 5.58 days; p = 0.001).
Scores
| Mortality
In-Hospital
| Mortality at 4 weeks
| Mortality at 6 weeks
|
ALBI
| AUC: 0.850
95% CI (0.780 - 0.921)
p: 0.000
| AUC: 0.881
95% CI (0.823 - 0.938) p: 0.000
| AUC: 0.867
95% CI (0.806 - 0.927) p: 0.000
|
Child Pugh (CP)
| AUC: 0.762
95% CI (0.668 - 0.857) p: 0.000
| AUC: 0.819
95% CI (0.739 - 0.900) p: 0.000
| AUC: 0.805
95% CI (0.728 - 0.881) p: 0.000
|
MELD | AUC: 0.714
95% CI (0.606 - 0.822) p: 0.002
| AUC: 0.785
95% CI (0.693 - 0.878) p: 0.000
| AUC: 0.786
95% CI (0.700 - 0.871) p: 0.000
|
MELD-Na
| AUC: 0.711
95% CI (0.599 - 0.823) p: 0.002
| AUC: 0.778
95% CI (0.683 - 0.873) p: 0.000
| AUC: 0.783
95% CI (0.696 - 0.870) p: 0.000
|
Multivariable analysis showed that:
- Higher ALBI score was significantly associated with mortality (Risk Ratio 25.80; 95% CI: 6.75–98.67; p < 0.001),
- Hospital stay <5 days (RR 9.91; 95% CI: 2.07–47.47; p = 0.004),
- Endoscopy performed within 12 hours (RR 7.53; 95% CI: 2.01–28.15; p = 0.003).
Conclusion
The ALBI score outperforms CP and MELD scores in predicting short-term mortality (in-hospital, 4 weeks, and 6 weeks) in cirrhotic patients with GI hemorrhage. Observed mortality was 10% in-hospital, 13% at 4 weeks, and 16% at 6 weeks.
