A Comparison of Prognostic Models for Predicting 6-Week Mortality in Patients with Acute Variceal Bleeding

Background and Aim: Acute variceal bleeding (AVB) in patients with cirrhosis continues to have high mortality. Predicting 6-week mortality from baseline variables is essential for optimal focused management of patients who are at higher risk of mortality. Many models have been used for predicting 6-week mortality, but most of them lack precision and require further validation. In this study, we aimed to find significant baseline predictors of 6-week mortality, develop a prognostic model using baseline variables, and compare the new model with the existing prognostic models using AUROC. Methods: We prospectively included cirrhotic patients presenting with acute variceal bleeding admitted to our hospital from January 2019 to September 2021. Patients with malignancy or with significant cardio-respiratory comorbidity were excluded. They were treated as per the standard guidelines using vasoactive drugs and endotherapy. They were followed for 6 weeks and baseline predictors of 6-week mortality were determined. Results: A total of 112 patients were included in the study (median age 49) [range 22-76], 87% males. The etiologies of cirrhosis were alcohol (66%), NASH (24%), HBV (4%), and others (5%). The baseline median (range) CTP, MELD and MELD-Na scores were 9 (5-15), 16 (6-40), and 18 (6-40), respectively. Eighteen percent of patients had active bleeding during initial endoscopy. Twenty-three (20%) patients died within 6 weeks of admission. Most patients died of progressive liver failure following AVB. On Cox regression analysis the independent baseline predictors of 6-week mortality were: hepatic encephalopathy, inotropic requirement, platelet count, creatinine, and albumin levels. Using these variables, a prognostic model was created (DELHI Model), which was compared with other existing models (CTP, MELD, MELD-Na, MELD-E, MELD-Na-E, CP-Cr, and AIMS65) in predicting 6-week mortality. The DELHI Model and MELD-E model were found to have the highest AUROC. Conclusion: In cirrhotic patients with AVB, the MELD-E model and our novel DELHI model predicts 6 weeks mortality with higher accuracy than the existing prognostic models.