Prediction of Recurrent Variceal Bleeding in Cirrhotic Patients after Endoscopic Variceal Ligation.

Ahmed, Nabila Hassan; Emam, Mohammed; Mohamed, Mohamed Abdelrahman; Sharaf, Ahmed Lotfy

doi:10.21608/zumj.2025.425611.4205

Prediction of Recurrent Variceal Bleeding in Cirrhotic Patients after Endoscopic Variceal Ligation.

Document Type : Original Article

Authors

¹ Hepatology & Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

² Hepatology and Gastroenterology Department, Zagazig Fever Hospital, Zagazig, Egypt.

10.21608/zumj.2025.425611.4205

Abstract

Background

Variceal rebleeding is a serious complication associated with increased hospital stay and mortality. Prediction of patients with high risk of recurrent variceal bleeding is important and challenging. This study aimed to assess relation between Albumin-Bilirubin (ALBI) grade and Platelet-Albumin-Bilirubin (PALBI) score and recurrence of variceal bleeding after endoscopic variceal ligation (EVL).

Methods

Cirrhotic patients (n = 240) with acute variceal bleeding were included. Child-Pugh (CTP) score, Model for end stage liver disease (MELD) score, ALBI grade and PALBI score were calculated for all patients. Upper GI endoscopy and EVL were done for all patients. Every patient was followed up for 6 months then classified into rebleeding and non-rebleeding groups.

Results

The validity of ALBI score at cutoff point -1.94 (grade 3) and PALBI score at cut-off value 3 in prediction of variceal rebleeding were the highest specific (82.14%, 89.29%) in comparison to MELD and CTP score (68%, 60.71%), and comparable sensitivity of ALBI grade to MELD and CTP score (71.88%, 75.86%, 84.38%) respectively, while PALBI score shows the least sensitivity 50%. Moreover, patients who died had a higher MELD, CTP scores, ALBI grade > 3 and a higher PALBI when compared to patients who survived. After applying logistic regression analysis, MELD score, CTP score, ALBI grade and PALBI score can be used as independent factors for predicting rebleeding post EVL.

Conclusion

ALBI grade and PALBI score have considerable sensitivity and specificity and can be used for predicting recurrent bleeding after EVL in cirrhotic patients.

Keywords

Main Subjects