Prediction of variceal hemorrhage and the relationship of clinicopathological features of esophageal variceal bleeding cases and the bleeding process

Objective: Esophagogastroduodenoscopy is the most commonly used method in the world to evaluate esophageal varices before bleeding. However, this is an expensive, difficult-to-access and inconvenient procedure for patients. Noninvasive markers based on clinical and laboratory parameters can be used to reduce cost in estimating bleeding risk. Patients and Methods: 200 patients diagnosed with cirrhosis and esophageal varices were included in the study. Groups were formed according to varicose bleeding and propranolol use. Laboratory values of the patients on the dates of endoscopies were noted. Univariate and multivariate logistic regression analyzes were used to find scores that could affect variceal bleeding. Results: Fib-4 and APRI scores in the univariate logistic model did not differ significantly between the groups with and without variceal bleeding (p>0.05). Child-P, Meld, Meld-Na and Lok scores were higher in the group with bleeding (p<0.01). The cut-off point was 0.825, with a sensitivity of 77% and a specificity of 51% for the Lok score. In ROC analysis, the area under the curve was 0.663 (0.587-0.738) at 99% confidence interval. Discussion and Conclusion: Cirrhosis is a disease with high mortality. Esophageal variceal bleeding is the most feared complication. The first preferred medical agent in prophylactic treatment is beta-blocker. There are scoring systems developed to evaluate the prognosis of cirrhosis. In our study, the most important predictor of varicose bleeding was Lok score. When the Lok score increased by 1 unit, the probability of bleeding increased 863,204 times. It turned out that Fib-4 and APRI scores were not useful predictors of esophageal variceal bleeding. On the other hand, Fib-4 and APRI were significantly higher in the propranolol group (p<0.05). Keywords: Liver cirrhosis, esophageal variceal bleeding, noninvasive markers, propranolol, Lok score