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EVALUATION OF THE PROGNOSTIC VALUE OF THE MAP (ASH) SCORE IN EARLY REBLEEDING AND IN-HOSPITAL MORTALITY IN CIRRHOTIC PATIENTS WITH GASTROINTESTINAL BLEEDING FROM ESOPHAGEAL VARICES AND GASTRIC VARICES
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Abstract
Objective: Assess the value of the MAP (ASH) score in predicting early rebleeding and in-hospital mortality in patients with cirrhosis experiencing gastrointestinal bleeding (GIB) due to ruptured esophageal varices (REV) and gastric varices (GV). Subjects and Methods: A cross-sectional descriptive study, non-control group, combined retrospective and prospective study on 197 cirrhotic patients with complications of GIB from REV and GV treated at Military Central Hospital 108 from September 2022 to December 2023. MAP (ASH) scores were calculated and compared with early rebleeding and in-hospital mortality rates. The predictive value was also compared with the Child-Pugh and AIMS65 scores. Results: The average MAP (ASH) score was 3.64 ± 1.68. The MAP (ASH) score showed good predictive value for in-hospital mortality with an AUROC of 0.812; 95% CI: 0.704-0.920; P < 0.01. At a cut-off of 5, it had a sensitivity of 55.6% and a specificity of 92.2%. The MAP (ASH) score demonstrated acceptable predictive value for early rebleeding with an AUROC of 0.787; 95% CI: 0.659-0.916, P < 0.01. At a cutoff of 4, it had a sensitivity of 71.4% and a specificity of 78.1%. Regarding early rebleeding, the MAP (ASH) score performed better predictive value than the Child-Pugh score, while regarding in-hospital mortality, there was no significant difference among the three scoring systems. Conclusion: The MAP (ASH) score is a valuable prognostic tool for predicting the risk of early rebleeding and in-hospital mortality in cirrhotic patients with GIB complications from REV and GV.
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Keywords
MAP (ASH) Score; Gastrointestinal bleeding from ruptured esophageal varices, gastric varices; Cirrhosis
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