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MELD, ultrasound Doppler index predicted variceal bleeding in patients with cirrhosis

The model for end-stage liver disease and ultrasound Doppler index system accurately predicted esophageal variceal bleeding in patients with decompensated cirrhosis, according to new research data.

Researchers recruited 486 patients (mean age, 63.1 years; 51% women) with cirrhosis who were admitted to the Changshu Affiliated Hospital of Suzhou University, China, and underwent ultrasound-Doppler (US-Doppler) and model for end-stage liver disease (MELD) assessments every 3 months. Of those patients, 416 completed follow-up evaluations and were followed for a mean of 31.6 months. The MELD-US-Doppler Index (MUI) was used during logistic regression analyses.

Fifty-one patients experienced esophageal variceal bleeding (EVB). They were older than patients without EVB (67.5 years vs. 62.3 years) and had a greater MELD score (26.5 ± 9.8 vs. 18.9 ± 10.3) and 3-month change in MELD score (1.89 ± 1.23 vs. 0.66 ± 0.47; P<.05 for all).

In multivariate analysis, EVB incidence was highly predictable for the MUI compared with the change in MELD score (OR=6.195; 95% CI, 1.193-22.624), left gastric vein blood flow velocity (OR=7.129; 95% CI, 2.725-24.256) and left gastric vein blood flow direction (LGVBFD; OR=23.306; 95% CI, 2.376-337.186).

The MUI index displayed high diagnostic accuracy (85.8%), high sensitivity (87.27%; 95% CI, 75.5-94.7) and high specificity (80%; 95% CI, 65.4-90.4) when established at 46. The change in MELD score, left gastric vein blood flow velocity and LGVBFD were independently associated with EVB occurrence among the cohort.

“The newly developed MUI presented here is a noninvasive, affordable and convenient index to assess EVB risk in decompensated cirrhosis patients,” the researchers concluded. “It is a suitable alternative for patients who have declined regular screening via endoscopy.

“Future prospective studies are warranted to further validate the clinical strength of this index.”

Disclosure: Relevant financial disclosures were not provided by researchers.