Development and validation of a scoring system for in-hospital mortality following band ligation in esophageal variceal bleeding

Objectives: We aimed to develop and validate a simplescoring system to predict in-hospital mortality after endoscopicvariceal ligation (EVL) for esophageal variceal bleeding. Methods: Data from a 13-year study involving 46 Japaneseinstitutions were split into development (initial 7 years) andvalidation (last 6 years) cohorts. The study subjects were patientshospitalized for esophageal variceal bleeding and treated withEVL. Variable selection was performed using least absoluteshrinkageandselection operatorregression,targetingin-hospitalall-cause mortality as the outcome. We developed the HospitalOutcome Prediction following Endoscopic Variceal Ligation(HOPE-EVL) score frombcoefficients of multivariate logisticregression and assessed its discrimination and calibration. Results: The study included 980 patients: 536 in the develop-ment cohort and 444 in the validation cohort. In-hospitalmortality was 13.6% and 10.1% for the respective cohorts. Thescoring system used five variables: systolic blood pressure(<80 mmHg: 2 points), Glasgow Coma Scale (<= 12: 1 point), totalbilirubin (>= 5 mg/dL: 1 point), creatinine (>= 1.5 mg/dL: 1 point),and albumin (<2.8 g/dL: 1 point). The risk groups (low: 0-1,middle: 2-3, high:>= 4) in the validation cohort corresponded toobserved and predicted mortality probabilities of 2.0% and 2.5%,19.0% and 22.9%, and 57.6% and 71.9%, respectively. In thiscohort, the HOPE-EVL score demonstrated excellent discrimi-nation ability (area under the curve [AUC] 0.890; 95% confidenceinterval [CI] 0.850-0.930) compared with the Model for End-stage Liver Disease score (AUC 0.853; 95% CI 0.794-0.912) andthe Child-Pugh score (AUC 0.798; 95% CI 0.727-0.869). Conclusions: The HOPE-EVL score practically and effectivelypredicts in-hospital mortality. This score could facilitate theappropriate allocation of resources and effective communica-tion with patients and their families.