Clinical Study on the Risk Stratification and Prognostic Value of Blatchford,AIMS65,Child-Pugh and MELD Scoring Systems in Patients with Liver Cirrhosis Accompanied by Esophageal and Gastric Variceal Bleeding in Highland Regions

Ciyang; Danzeng Zhuoga; Basang Zhuoma; Yibi Ranhen; Wang Wenhai

doi:10.3969/j.issn.1004-3403.2025.10.008

Abstract：Objective This study aimed to stratify the risk of patients with liver cirrhosis accompanied by esopha-geal and gastric variceal bleeding(EGVB)in highland regions using the Blatchford,AIMS65,Child-Pugh and MELD scoring systems in order to evaluate and compare the predictive value of each scoring system for different interventions(blood transfusion,endoscopic treatment,ICU admission)and prognosis(re-bleeding,mortality).Methods Clinical baseline data were collected from 139 patients with decompensated liver cirrhosis accompanied by EGVB admitted to the Department of Gastroenterology,Lhasa People's Hospital from September,2021 to De-cember,2023,who were scored using Blatchford,AIMS65,Child-Pugh and MELD scoring systems.Data on ICU admission,blood transfusion,endoscopic intervention,re-bleeding and mortality within three months after bleeding were recorded.Predictive value of the four scoring systems for the prognosis of patients with liver cirrhosis accom-panied by EGVB was analyzed using Receiver Operating Characteristic(ROC)curve.Results Among the 139pa-tients,19 were stratified into the low-risk group and 120 into the medium-to-high-risk group according to Blatch-ford.104 patients were stratified into the low-risk group and 35 into the high-risk group according to AIMS65.48 patients were stratified into the low-risk group,58 into the medium-risk group and 33 into the high-risk group ac-cording to Child-Pugh.123 patients were stratified into the low-risk group,6 into the medium-risk group and 10 into the high-risk group according to MELD.No statistically significant differences were observed between the survival and mortality groups in terms of gender,age,etiology,portal vein thrombosis,liver cancer,severity of anemia or Blatchford scores(P>0.05)while statistically significant differences were observed in terms of residential altitude,length of hospital stay,AIMS65,Child-Pugh and MELD scores(P<0.05).No statistically significant differences were observed in re-bleeding rate across risk stratification of the four scoring systems(P>0.05)while statistically significant differences were observed in mortality rate across risk stratification of AIMS65,Child-Pugh and MELD(P<0.05).ROC curve analysis showed that all of the four scoring systems had predictive value for patient mortali-ty,with AUC value at 0.536,0.678,0.794 and 0.680,respectively.Conclusion All of the four scoring systems dem-onstrated predictive value for mortality of patients with liver cirrhosis accompanied by EGVB,among which,Child-Pugh had the highest predictive value,followed by AIMS65 and MELD.The predictive efficacy of these four scor-ing systems for re-bleeding was poor.