Development and Validation of CAGIB Score for Evaluating the Prognosis of Cirrhosis with Acute Gastrointestinal Bleeding: A Retrospective Multicenter Study.
INTRODUCTION
Acute gastrointestinal bleeding (GIB) is a major cause of death in liver cirrhosis. This multicenter study aims to develop and validate a novel and easy-to-access model for predicting the prognosis of patients with cirrhosis and acute GIB.


METHODS
Patients with cirrhosis and acute GIB were enrolled and randomly divided into the training (n = 865) and validation (n = 817) cohorts. In the training cohort, the independent predictors for in-hospital death were identified by logistic regression analyses, and then a new prognostic model (i.e., CAGIB score) was established. Area under curve (AUC) of CAGIB score was calculated by receiver operating characteristic curve analysis and compared with Child-Pugh, model for end-stage liver disease (MELD), MELD-Na, and neutrophil-lymphocyte ratio (NLR) scores.


RESULTS
In the training cohort, hepatocellular carcinoma (HCC), diabetes, total bilirubin (TBIL), albumin (ALB), alanine aminotransferase (ALT), and serum creatinine (Scr) were independent predictors of in-hospital death. CAGIB score = diabetes (yes = 1, no = 0) × 1.040 + HCC (yes = 1, no = 0) × 0.974 + TBIL (μmol/L) × 0.005 - ALB (g/L) × 0.091 + ALT (U/L) × 0.001 + Scr (μmol/L) × 0.012 - 3.964. In the training cohort, the AUC of CAGIB score for predicting in-hospital death was 0.829 (95% CI 0.801-0.854, P < 0.0001), which was higher than that of Child-Pugh (0.762, 95% CI 0.732-0.791), MELD (0.778, 95% CI 0.748-0.806), MELD-Na (0.765, 95% CI 0.735-0.793), and NLR (0.587, 95% CI 0.553-0.620) scores. In the validation cohort, the AUC of CAGIB score (0.714, 95% CI 0.682-0.746, P = 0.0006) remained higher than that of Child-Pugh (0.693, 95% CI 0.659-0.725), MELD (0.662, 95% CI 0.627-0.695), MELD-Na (0.660, 95% CI 0.626-0.694), and NLR (0.538, 95% CI 0.503-0.574) scores.


CONCLUSION
CAGIB score has a good predictive performance for prognosis of patients with cirrhosis and acute GIB.
['Bai|Zhaohui|Z|', 'Li|Bimin|B|', 'Lin|Su|S|', 'Liu|Bang|B|', 'Li|Yiling|Y|', 'Zhu|Qiang|Q|', 'Wu|Yunhai|Y|', 'Yang|Yida|Y|', 'Tang|Shanhong|S|', 'Meng|Fanping|F|', 'Chen|Yu|Y|', 'Yuan|Shanshan|S|', 'Shao|Lichun|L|', 'Qi|Xingshun|X|0000-0002-9448-6739']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D006528:Carcinoma, Hepatocellular D015331:Cohort Studies D005260:Female D006471:Gastrointestinal Hemorrhage D006801:Humans D008103:Liver Cirrhosis D008113:Liver Neoplasms D008297:Male D008875:Middle Aged D011379:Prognosis D012189:Retrospective Studies D012720:Severity of Illness Index D055815:Young Adult
Prognosis Cirrhosis Gastrointestinal bleeding MELD Child–Pugh