### Description

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)