Prognostic Value OF MELD Score IN Acute Variceal Bleeding

Introduction: The Child-Pugh (CP) score has long been used in predicting mortality in acute variceal bleeding. The model of end-stage liver disease (MELD) score was originally determined to predict survival in cirrhotic patients undergoing surgery. It is now used to assign priority for liver transplantation. MELD score is a useful tool to assess prognosis in critically ill cirrhotic patients. There is conflicting results have been found on the comparison between MELD and CP score performance in predicting mortality after variceal bleeding. The aim of this study was to determine the prognostic use fullness of MELD score in cirrhotic patients presented with acute variceal bleeding. Patients and methods: This prospective study included 200 consecutive patients with liver cirrhosis presented with first attack of acute variceal bleeding. After giving appropriate pharmacological and endoscopic therapy, each patient was assigned a Child and MELD score and all patients were followed up for 6 weeks to assess the outcome (re-bleeding or death). Results: Thirty nine patients (19.5%) died through out the follow up period of 6weeks. Of these deaths, 12(6%) occurred within the first 5 days (in-hospital mortality) and 23 (11.5%) patients had re-bleeding. Patients who died in hospital had significantly higher MELD score as well as Child score compared to the survivors (35.6±4.35 & 12.8 ± 0.9 vs. 13.8 ±7.9 & 7.4 ±2.43 respectively P<0.01). Moreover MELD and Child scores were higher among patients who died allover the 6 weeks when compared to those who survived (28.9 ± 6.4&8.4 ±5.3vs. 10.56 ± 2.5& 6.6 ± 1.2 respectively P <0.001). MELD score was superior to Child score in prediction of both mortality and re-bleeding after acute variceal bleeding. As MELD score ≥ 12 and Child score ≥6 were associated with re-bleeding (accuracy 90.2% vs. 82% and AUC 0.739 vs. 0.591 respectively), while MELD score≥ 17 and Child score ≥ 9 were associated with mortality (accuracy 98% vs. 87% and AUC 0.768 vs. 0.556 respectively). Conclusion and recommendation: MELD score allow for early identification of patients with acute variceal bleeding who are at substantially increased risk of re-bleeding or death over the short term. These patients may require care in more specialized units during the bleeding episode, and aggressive follow-up in the immediate post variceal bleed setting. [Researcher 2010;2(4):22-27]. (ISSN: 1553-9865).