Augustin et al developed a classification and regression tree (CART) model for predicting the risk of early mortality in a patient with acute variceal bleeding. This can help to identify a patient who may benefit from more aggressive management. The authors are from Hospital Universitari Vall d’Hebron and Universitat Autonoma de Barcelona in Spain.
Patient selection: acute variceal bleed
Outcome: death within 6 weeks (early mortality)
Parameters:
(1) Child-Pugh score
(2) bacterial infection (any of the following during the first 5 days after the initial bleed: fever > 37.5°C for > 12 hours, pneumonia, urinary tract infection, spontaneous bacterial peritonitis, elevated neutrophils in the ascites fluid, positive blood culture)
(3) serum creatinine concentration
Child Pugh Score
Bacterial Infection
Serum Creatinine
Early Mortality
<= 7
NA
NA
0-8% (low risk)
> 7
Yes
NA
38-73% (high risk)
> 7
No
<= 1.35 mg/dL
17% (intermediate)
> 7
No
> 1.35 mg/dL
50% (high risk)
based on training and validation groups
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