Platelet-albumin-bilirubin score - a predictor of outcome of acute variceal bleeding in patients with cirrhosis

Table 1 Characteristics of all studied participants

Variable	Number/mean (%)	Median	SD
Age (yr)	52.6	52	10.3
Male:Female	1176 (77.5):341 (22.5)	-	-
In-hospital mortality	332 (21.9)	-	-
Serum albumin (g/dL)	2.4	2.4	0.6
Serum total bilirubin (μmol/L)	64.98	30.78	99.18
Serum creatinine (mg/dL)	1.3	1	0.97
International normalized ratio (INR)	1.7	1.6	0.53
Hemoglobin level (g/dL)	9.5	9.4	2.35
Hematocrit	28.8	29	6.25
Platelet count (× 103/mm3)	116	104	56
Blood units transfused	2.8	2	1.1
Time to first endoscopy (h)	5.6	4	1.9
Duration of admission (d)	5	4	3.3
MELD score	15.2	14.8	3.2

SD: Standard deviation; MELD: Model of End-stage Liver Disease.

Table 2 Treatment modalities

Treatment modality	n (%)
Band ligation	785 (51.8)
Sclerotherapy	301 (19.9)
Fundal varix (histoacryl injection alone)	165 (10.8)
Combined treatment	197 (13)
Conservative treatment	69 (4.5)

Table 3 Patients distribution according to Child Turcotte Pugh, Albumin-bilirubin, Model of End-stage Liver Disease and Platelet-albumin-bilirubin scores

Class	No. of patients (%)	Bleeding mortality (%)
CTP A	69 (4.5)	0
CTP B	434 (29.2)	11
CTP C	1014 (66.8)	28
MELD < 12	186 (12)	0
MELD 12-20	353 (23.5)	16.3
MELD > 20	978 (64.5)	31.9
ALBI grade 1	26 (1.7)	0
ALBI grade 2	669 (44.1)	7.2
ALBI grade 3	822(54.1)	34.5
MELD-AVB < 11	159 (10.5)	0
MELD-AVB 11-19	370 (24.4)	14.3
MELD-AVB > 19	988 (65.1)	36.3
PALBI grade 1	306 (20.2)	0
PALBI grade 2	285(18.8)	21.8
PALBI grade 3	926 (61)	34.4

PALBI: Platelet-albumin-bilirubin score; ALBI: Albumin-bilirubin; MELD: Model of End-stage Liver Disease; CTP: Child Turcotte Pugh; MELD-AVB: MELD-acute variceal bleeding.

Table 4 Predictors of rebleeding

Parameter	OR	95%CI	P value
PALBI	3.987	1.994-7.775	< 0.001
Conservative therapy	2.473	1.237-4.822	< 0.001
Previous beta blockers	0.387	0.194-0.755	< 0.001
ALBI	3.214	1.607-6.267	< 0.01
Time to endoscopy	1.572	1.086-3.065	< 0.01
Ascites	2.319	1.160-4.522	< 0.05
Spleen size	1.961	1.181-3.824	< 0.05
Diabetes	1.631	1.116-3.180	< 0.05
Platelet count	0.445	0.223-0.868	< 0.05
INR	1.618	1.109-3.155	< 0.05
Bilirubin	1.981	1.291-3.863	< 0.05
Albumin	0.613	0.457-0.897	< 0.05

ALBI: Albumin-bilirubin; PALBI: Platelet-albumin-bilirubin score; INR: International normalized ratio.

Table 5 Multivariate analysis: Predictors of in-hospital mortality

Parameter	OR	95%CI	P value
PALBI	4.187	2.093-8.164	< 0.001
MELD-AVB	3.842	2.983-7.431	< 0.01
ALBI	3.153	1.576-6.148	< 0.001
MELD	2.981	1.490-5.812	< 0.001
CTP	2.144	1.072-4.180	< 0.01
Bilirubin	1.981	1.015-3.862	< 0.01
Albumin	0.269	0.134-0.524	< 0.01
Age	1.718	1.034-3.350	< 0.05
Ascites	1.547	1.173-3.016	< 0.05
Encephalopathy	1.869	1.124-3.644	< 0.05
Hematocrit	0.191	0.095-0.372	< 0.05
Platelet count	0.543	0.321-0.853	< 0.05
INR	1.923	1.061-3.749	< 0.05
Creatinine	1.561	1.180-3.043	< 0.05

PALBI: Platelet-albumin-bilirubin score; ALBI: Albumin-bilirubin; MELD: Model of End-stage Liver Disease; CTP: Child Turcotte Pugh; MELD-AVB: MELD-acute variceal bleeding; INR: International normalized ratio.

Table 6 Area under the receiver operating characteristic curve values of different scores to predict the outcome of acute variceal bleeding and the incidence of rebleeding

Predicting outcome of acute variceal bleeding
Score	CTP	MELD	ALBI	MELD-AVB	PALBI
AUROC	0.668	0.689	0.803	0.849	0.871
P value1	< 0.01	< 0.01	< 0.01	0.043	-
Predicting rebleeding
Score	CTP	MELD	ALBI	MELD-AVB	PALBI
AUROC	0.681	0.74	0.766	0.769	0.794
P value1	< 0.01	< 0.05	0.052	0.032	-

¹P values are tested with Delong test between each consecutive test. PALBI: Platelet-albumin-bilirubin score; ALBI: Albumin-bilirubin; MELD: Model of End-stage Liver Disease; CTP: Child Turcotte Pugh; MELD-AVB: MELD-acute variceal bleeding; INR: International normalized ratio.