Conclusions: Embolization of splenic artery, especially when performed after B-RTO, contributes to controlling the elevation of PVP and promoting the improvement in hepatic function induced by occlusion of PSS in cirrhotic patient. Disclosures: Shuji Terai – Speaking and Teaching: Otsuka Pharma. The following people have nothing to disclose: Tsuyoshi Ishikawa, Shogo Shirat-suki, Takashi Inhibitor Library price Matsuda, Takuya Iwamoto, Taro Takami, Isao Sakaida BACKGROUD The mortality rate after acute variceal
bleeding (AVB) is high, especially in patients complicated with decom-pensated liver function and/or advanced hepatocellular carcinoma (HCC). There are some good prognostic models, such as models for end-stage liver disease (MELD) for liver function and the staging system for HCC. Although several reports indicated that each model was also good predictive tool for prognosis in patients with AVB, there have been no models based on both the stage of HCC and the degree
of liver function to predict the prognosis in patients with AVB, AIM To develop a new scoring system based on both liver function and the stage of HCC to predict mortality within 30 days after AVB in patients with cirrhosis selleck products METHOD AND RESULT Of a total of 818 cases of gastroesophageal varices diagnosed by endoscopy at our department between January 2003 and PRKACG December 2013, 148 cases of AVB treated by endoscopic variceal ligation were analyzed. We compared three prognostic models, including Child-Pugh Score, MELD score and MELD-Na score, to determine the best model for predicting 30-day mortality after AVB by analyzing the ROC curves. The best discrimination model was obtained by MELD-Na (AUROC = 0.762). On multivariate analysis, the significantly associated factors with 30-day mortality were MELD-Na (OR 1.163(1.071-1.263), p<0.001) and the presence of HCC (OR 7.813(2.545-24.39), p<0.001). MELD-Na score and the stage of HCC were scored according
to the severity as followings: [MELD-Na score] (14≧) = 1 point, (15-19) = 2 points, (20-24) = 3 points, (≧25) = 4 points, [the stage of HCC] (absence of HCC or stage I) = 1 point, (stage II) = 2 points, (stage III or IV) = 3 points. Combing these scores, we developed a new scoring system (range 2 to 7 points). This scoring system showed high predictive ability (AUROC = 0.893 (0.761-0.917)), and the sensitivity and specificity of score ≧ 4 were 81.5% and 81.1% respectively for predicting 30-day mortality. CONCLUSION Our new scoring system based on both MELD-Na and the stage of HCC is useful to predict mortality within 30 days after AVB in patients with cirrhosis.
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