GIÁ TRỊ PHỐI HỢP THANG ĐIỂM MAP(ASH) VÀ CHỈ SỐ MELD TRONG TIÊN LƯỢNG BỆNH NHÂN XƠ GAN CÓ XUẤT HUYẾT TIÊU HÓA DO VỠ GIÃN TĨNH MẠCH THỰC QUẢN

Abstract

Objective: To evaluate the effectiveness of combining the MAP(ASH) score and MELD index in predicting 90-day mortality and rebleeding in patients with cirrhosis and gastrointestinal bleeding (GIB) due to esophageal variceal rupture. Methods: A prospective descriptive study was conducted on 114 cirrhotic patients with GIB caused by esophageal varices at the Gastroenterology and Hepatology Center, Bach Mai Hospital, from October 2024 to May 2025. MAP(ASH) and MELD scores were assessed within the first 24 hours of hospital admission. Patients were then monitored for rebleeding and mortality over a 90-day period. Results: In predicting 90-day rebleeding, the combination of MAP(ASH) ≥ 4 and MELD ≥ 14 showed good prognostic performance with with an AUC of 0.785, sensitivity of 84%, specificity of 73%, positive predictive value (PPV) of 46.7%, and negative predictive value (NPV) of 94.2%, and p < 0.001. For 90-day mortality prediction, the combination of MAP(ASH) ≥ 5 and MELD ≥ 16 demonstrated high prognostic accuracy with an AUC of 0.833, sensitivity of 80%, specificity of 85.6%, PPV of 36.4%, and NPV of 97.8%, and p < 0.001. Conclusion: The results indicate that the combination of MAP(ASH) ≥ 4 and MELD ≥ 14 is effective in predicting 90-day rebleeding, while MAP(ASH) ≥ 5 and MELD ≥ 17 provide a strong prognostic value for 90-day mortality.