Child-Pugh versus APACHE II Scoring Systems for Prognosis Prediction of Acute Variceal Upper Gasterointestinal Bleeding

: Background Accurate risk stratification for patients with acute variceal upper gastrointestinal bleeding would be useful for identifying low-risk patients, who might not require hospitalization and high-risk patients, who require aggressive care in a closely monitored setting. Objectives: To evaluate the application of Child-Pugh and APACHE II scoring systems in the prediction of outcome of patients with acute variceal upper gastrointestinal bleeding. Patients and Methods: 100 patients were included prospectively. Clinical and laboratory data necessary to both Child-Pugh and APACHE II scores were calculated through 24 hours following admission. During hospitalization patients' outcome was reported. Discrimination was tested using the receiver operating characteristic curves and by comparing areas under the curve. Results: 26 patients developed one or more complications, 13 patients developed rebleeding without statistical significant Child-Pugh and APACHE II scores, 3 patients developed renal failure, 21patients had hepatic encephalopathy. All Child A patients survived, only one out of Child B patients died (2.2%) and 9 patients in Child C died (23.7%). Child-Pugh score cut off value for mortality was more than 10, with sensitivity 90%, specificity 77.5%, positive predictive value 31%, negative predictive value 98.6% and accuracy 80.4%. While applying APACHE II score, it was found that the cut off value was more than 15, with sensitivity 70%, specificity 77.8%, positive predictive value 25.9%, negative predictive value 95.9% and accuracy 70.6%. Conclusions: APACHE II and Child-Pugh scoring systems are useful for risk stratification of patients with acute variceal bleeding regarding mortality but not for rebleeding. It is preferred to use Child-Pugh score as a more sensitive score as well as more easy to apply to predict mortality.