Systematic review and meta-analysis of risk scores in prediction for the clinical outcomes in patients with acute variceal bleeding

Abstract

Background: Acute variceal bleeding (AVB) is a life-threatening condition that needs risk stratification to guide clinical treatment. Which risk system could reflect the prognosis more accurately remains controversial. We aimed to conduct a meta-analysis of the predictive value of GBS, AIMS65, Rockall (clinical Rockall score and full Rockall score), CTP and MELD. Method: PubMed, Web of Science, Embase, Cochrane library, WANGFANG and CNKI were searched. Twenty-eight articles were included in the study. The Meta-DiSc software and MedCalc software were used to pool the predictive accuracy. Results: Concerning in-hospital mortality, CTP, AIMS65, MELD, Full-Rockall and GBS had a pooled AUC of 0.824, 0.793, 0.788, 0.75 and 0.683, respectively. CTP had the highest sensitivity of 0.910 (95% CI: 0.864–0.944) with a specificity of 0.666 (95% CI: 0.635–0.696). AIMS65 had the highest specificity of 0.774 (95% CI: 0.749–0.798) with a sensitivity of 0.679 (95% CI: 0.617–0.736). For follow-up mortality, MELD, AIMS65, CTP, Clinical Rockall, Full-Rockall and GBS showed a pooled AUC of 0.798, 0.77, 0.746, 0.704, 0.678 and 0.618, respectively. CTP had the highest specificity (0.806, 95% CI: 0.763–0.843) with a sensitivity of 0.722 (95% CI: 0.628–0.804). GBS had the highest sensitivity 0.800 (95% CI: 0.696–0.881) with a specificity of 0.412 (95% CI: 0.368–0.457). As for rebleeding, no score performed particularly well. Conclusions: No risk scores were ideally identified by our systematic review. CTP was superior to other risk scores in identifying AVB patients at high risk of death in hospital and patients at low risk within follow-up. Guidelines have recommended the use of GBS to risk stratification of patients with upper gastrointestinal bleeding. However, if the cause of upper gastrointestinal bleeding is suspected oesophageal and gastric varices, extra care should be taken. Because in this meta-analysis, the ability of GBS was limited.Key message CTP was superior in identifying AVB patients at high risk of death in hospital and low risk within follow-up. GBS, though recommended by the Guidelines, should be cautiously used when assessing AVB patients.