Prognostic Index of Ben-Ari et al for Failure to Control Acute Variceal Bleeding

 

Failure to control bleeding was defined as bleeding from time 0 to day 5.

 

Parameters:

(1) hepatic encephalopathy

(2) history of alcoholism

(3) platelet count in 10^9/L

(4) hours to hospital admission

(5) duration of active bleeding (<= 6 hours vs > 6 hours)

(6) urea in mg/dL

(7) hematemesis

Parameter	Finding	Points
encephalopathy	absent	0
	present	1
history of alcoholism	absent	0
	present	1
platelet count	X * 10^9/L	X
hours to hospital admission	hours	log (hours)
duration of bleeding <= 6 hours	no	0
	yes	1
duration of bleeding > 6 hours	no	0
	yes	1
urea	in mg/dL	log (urea)
hematemesis	absent	0
	present	1

 

where:

• The difference between the coefficients for duration of active bleeding are very similar (1.19 vs 1.18). I am not sure what this factor brings to the model.

• Urea is reported in mg/dL rather than mmol/L. It does not appear to be referring to BUN. Conversion from mg/dL urea to mmol/L uses a factor of 0.167.

 

prognostic index =

= (0.5 * (points for encephalopathy)) + (0.42 * (points for history of alcoholism)) - (0.005 * (points for platelet count)) - (0.12 * (points for hours to admission)) + (1.19 * (points for active bleeding <= 6 hours)) + (1.18 * (points for active bleeding > 6 hours)) + (0.34 * (points for urea)) + (0.61 * (points for hematemesis))

 

Interpretation:

• The PI was developed in a group treated initially with blood transfusion and vasoactive drugs. If this failed then sclerotherapy was performed.

• The PIs were divided into quintiles (<= 0.8, 0.9 - 1.1, 1.2 - 1.6, 1.7 - 2.1, and >= 2.2).

• The higher the PI the higher the percentage of patients who failed to have bleeding controlled.

 

Limitations:

• "Log" is not specified as base 10 or natural log.