Comparison of the efficacy of platelet-albumin-bilirubin score vs. Child-Turcotte-Pugh, Model for End-Stage Liver Disease-Sodium, and complete Rockall score in predicting rebleed and mortality in patients presenting with variceal bleed

BACKGROUND: Acute variceal bleeding (AVB) comprises 70% of upper gastrointestinal bleeding in cirrhotic individuals, with first-episode mortality of 15-20%. A third of surviving patients rebleed within 6 weeks of initial presentation. Scores such as Child-Turcotte-Pugh (CTP), model for end-stage liver disease-sodium (MELD-Na), and complete Rockall score (CRS) predict such outcomes, but with limitations. The platelet-albumin-bilirubin (PALBI) score is an attractive, rapid scoring system for predicting 6-week adverse outcomes after AVB. AIM: To correlate 5-day and 6-week outcomes after AVB with the PALBI score against the MELD-Na, CTP, and CRS. METHODS: Two hundred fifty patients presenting with AVB over the 20-month study period were investigated. CTP, MELD-Na and PALBI, and CRS scores were calculated; patients were followed for 6 weeks. The areas under the receiver-operator characteristic curves (AUROCs) were compared. RESULTS: The most common etiology for cirrhosis was ethanol (52.8%). Sixty-five patients were PALBI-1 (26%), 46 PALBI-2 (18.4%), and 139 PALBI-3 (55.6%). Ninety-five rebleeding events (30%) and 30 mortalities (12%) were noted over the follow-up period. AUROCs for predicting adverse outcomes at 5 days were 0.888 for CTP, 0.833 for MELD-Na, 0.777 for CRS, and 0.720 for PALBI; and at 6 weeks, were 0.885 for CTP, 0.821 for MELD-Na, 0.709 for CRS, and 0.856 for PALBI. AUROCs were statistically significant ( P < 0.001). Compared to other scores, PALBI showed no statistically significant difference compared to the MELD-Na and CTP scores at week 6. CONCLUSION: PALBI score on admission is a good predictor of adverse outcomes within 6 weeks in patients who present with variceal bleed.