Predictive value of pre-treatment platelet-to-albumin ratio in short-term prognosis of endoscopic treatment for cirrhosis with esophageal and gastric variceal bleeding / 中国医师进修杂志

ABSTRACT

Objective:To explore the predictive value of pre-treatment platelet-to-albumin ratio (PAR) in short-term prognosis of endoscopic treatment for cirrhosis with esophageal and gastric variceal bleeding(EGVB).Methods:By retrospective analysis method, the clinical data of 195 cirrhotic patients with EVGB from January 2019 to April 2022 treatment at Bengbu First People′s Hospital were collected and analyzed. The PAR was calculated according to platelet count and albumin. The independent risk factors that affecting 6-week rebleeding and death were analyzed by univariate and multivariate Cox regression, the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of PAR for rebleeding and death, and Kaplan-Meier survival analysis was used to evaluate the rebleeding rate and survival rate of patients with different PAR ratios.Results:Among 195 patients, 36 patients were rebleeding and 159 patients were non-rebleeding within 6 weeks; while 15 cases died and 180 cases survived. The platelet count, PAR in the rebleeding group were lower than those in the non-rebleeding group, the direct bilirubin, triglyceride, alanine transaminase, prothrombin time and mortality in the rebleeding group were higher than those in the non-rebleeding group: 74.0(66.5, 88.8) × 10 9/L vs. 98.0(85.0, 111.0)×10 9/L, 2.48(2.18, 2.78) vs. 3.35(2.81, 4.04), 18.5(14.0, 23.8) μmol/L vs. 16.0(11.0, 20.0) μmol/L, (4.73 ± 2.52) mmol/L vs. (3.94 ± 1.65) mmol/L, 36.0(27.0, 46.0)U/L vs. 21.0(13.3, 33.0)U/L, (14.78 ± 1.63) s vs. (13.47 ± 0.87) s, 36.11%(13/36) vs. 1.26%(2/159), there were statistical differences ( P<0.05). Cox multivariate regression showed that PAR, alanine transaminase were the independent risk factors for the rebleeding ( P<0.05), PAR was the independent risk factor for the death within 6 weeks ( P<0.05). The area under the curve (AUC) of PAR for predicting 6-week rebleeding and death was 0.876, 0.776, the cut-off was 2.94, 2.71, the specificity was 69.8%, 72.2%, the sensitivity was 94.4%, 73.3%, respectively. According to the cut-off of PAR to predict rebleeding, the 6-week rebleeding rate in the PAR≤2.94 group was higher than that in the PAR>2.94 group ( χ2 = 36.88, P<0.01). According to the cut-off of PAR to predict death, the 6-week mortality rate in the PAR≤2.71 group was higher than in the PAR>2.71 group ( χ2 = 16.44, P<0.01). Conclusions:PAR can be used as a predictor for rebleeding and death within 6 weeks of EGVB in cirrhotic patients.