Patients with hepatic cirrhosis who have had an episode of upper gastrointestinal bleeding have a significant short term mortality rate, often related to additional bleeding. The short term prognosis can be estimated using a simple prognostic index using clinical and laboratory data.
Patient selection:
(1) The study involved collaboration between 8 internal medicine departments at hospitals in Italy.
(2) Included patients had a diagnosis of hepatic cirrhosis and upper GI bleed as evidenced by hematemesis or melena.
(3) 268 patients with 332 episodes of bleeding were analyzed.
Calculating the Prognostic Index
SUM A =
= (-0.016 * (serum creatinine in µmol/L)) - (0.010 * (serum bilirubin in µmol/L)) + (0.036 * (prothrombin index in percent))
where:
• In Table 6, page 1535, creatinine is given as mM/L, but it is µM/L in Table 4 page 1534.
• The prothrombin index in percent is read off a plot of plasma dilutions (100%, 50%, 25%, etc.) vs PT in seconds. However, this is not routinely done in the US anymore.
• In the footnote on page 1535, it says that the expression (7 - (0.38 * (prolongation of the prothrombin time in seconds above normal))) can be used in place of the prothrombin index, but I am not sure exactly what is meant . It may substitute for the entire expression (0.036 * (prothrombin index in percent)) or the prothrombin index only.
|
Parameter
|
Finding
|
Value
|
|
ascites
|
present
|
-0.306
|
|
|
absent
|
0.306
|
|
hepatocellular carcinoma
|
present
|
-0.842
|
|
|
absent
|
0.842
|
|
bleeding from varices
|
present
|
-0.442
|
|
|
absent
|
0.442
|
|
gender
|
male
|
-0.386
|
|
|
female
|
0.386
|
|
hematemesis at presentation
|
present
|
-0.405
|
|
|
absent
|
0.405
|
SUM B and C =
= (points for ascites) + (points for hepatocellular carcinoma) + (points for variceal bleeding) + (points for gender) + (points for hematemesis)
where:
• This is a slight modification of Table 4 page 1532 and Table 6, page 1535.
prognostic index = PI =
= 1.21 + (SUM A) + (SUM B and C)
Interpretation
probability of survival at 40 days =
= EXP(PI) / (1 + EXP(PI))
probability of death by 40 days =
= 1 - (probability of survival)
