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Prognostic Index of Zoli et al for Prediction of the First Bleeding from the Upper Gastrointestinal Tract in a Patient with Cirrhosis

Purpose: To predict the risk of first time upper GI bleeding in a patient with cirrhosis using the prognostic index (PI) of Zoli et al.

Description

Zoli et al developed a new prognostic index (PI) to predict first upper gastrointestinal tract bleeding in patients with cirrhosis. This can help identify those patients who may benefit from more aggressive management and monitoring. The authors are from the Universities of Bologna and Padova in Italy.


Parameters identified on multivariate analysis as independent predictors of bleeding:

(1) size of the largest varix relative to the radius of the esophageal lumen

(2) congestive gastropathy

(3) gastric varices

 

Parameter

Finding

Points

size of the largest varix

 

(diameter varix) / (radius esophagus) * 100%

congestive gastropathy

absent

0

 

mild to moderate

1

 

severe

2

gastric varices

absent

0

 

present

1

 

where:

• The description of the varix size is a little ambiguous. I interpret it as meaning the diameter of the largest varix relative to the radius of the esophageal lumen.

• The size of the varix is a whole number from 0 to 100.

 

PI =

= (0.0395 * (size of the largest varix)) + (0.878 * (points for congestive gastropathy)) + (0.705 * (points for gastric varices))

 

Interpretation:

• minimum PI: 0

• maximum PI: 6.411

• The higher the PI the greater the risk of bleeding.

 

PI

Risk of Bleeding in 1 Year

<= 2.56

0 - 20%

2.57 - 3.25

21 - 40%

3.26 - 3.97

41 - 60%

3.98 - 4.51

61 - 80%

>= 4.52

81 - 100%

from Table 6, page 1050

 

PI

Risk of Bleeding in 2 Years

<= 1.88

0 - 20%

1.89 - 2.66

21 - 40%

2.67 - 3.25

41 - 60%

3.26 - 3.77

61 - 80%

>= 3.78

81 - 100%

from Table 6, page 1050


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Specialty

Objective

ICD-10