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Background. Acute variceal bleeding (AVB) is a potentially life-threatening condition associated with high mortality among cirrhotic patients. Various risk scores are used in risk stratification for non-variceal bleed, but their utility in AVB remains unclear. OBJECTIVE: The aim of the study is to compare systems in predicting in-hospital mortality in cirrhotic patients with acute variceal bleeding - Model for End-Stage Liver Diseases (MELD), Child-Pugh, Glasgow-Blatchford Bleeding (GBS) and Rockall scores. Methods. We retrospectively included all cirrhotic patients admitted to the emergency room with acute variceal hemorrhage between 2017 to 2021, that underwent upper gastrointestinal endoscopy with endoscopic hemostasis (band ligation) in the emergency department of SCJU Targu-Mures. Results. A total of 210 patients were included (male/female: 165/45; mean age: 59.12±11.76 years; Child-Pugh class A/B/C: 47/91/72). The main endpoint of the study was the in-hospital outcome, 83% of patients (n = 175) survived while 17% (n = 35) died. The mean Glasgow-Blatchford score was 12.68 ± 3.25 vs 15.31 ± 2.91 (p<0.0001), Rockall score 6.98 ± 0.86 vs. 7.68 ±1.02 (p<0.0001) and MELD score 12.78±4.73 vs. 15.31±2.91 (p<0.0001). Areas under receiving-operator characteristics curve (AUROC) for predicting the in-hospital mortality were compared. AUROCs for predicting the in-hospital mortality for Child-Pugh score was 0.714 (95% confidence interval [CI]: 0.648-0.774), GBS 0.731 (95% CI: 0.666-0.790), MELD score 0.767 (95% confidence interval [CI]: 0.704-0.823), respectively for Rockall score was 0.699 (95% confidence interval [CI]: 0.632-0.760). Conclusions. The present study shows that MELD score is an excellent indicator in in-hospital mortality of acute UGIB in cirrhotic patients. [ABSTRACT FROM AUTHOR]

Objectives: The current study aimed at evaluating the association between metabolic syndrome (MeS) in patients with hepatitis C virus (HCV) liver cirrhosis (compensated, genotype, 1b) and changes after sustained viral response (SVR) following a 12-week therapy with paritaprevir, ritonavir, ombitasvir, dasabuvir, and ribavirin (PrOD+R). Methods: The current multicenter retrospective study included 809 patients diagnosed with compensated HCV cirrhosis (child class A), all 1b genotype treated for 12 weeks with direct acting antiviral agents - PrOD+R - regimen (according to the protocol practiced in Romania) and achieved SVR. The parameters of MeS (according to the definition of the International Diabetes Federation) were collected from medical records before and 12 weeks after the treatment. The results were collected in a central database and analyzed with SPSS 18.0. Statistical analysis used both descriptive and analytical methods with a significance level of 95% (CI 95%). Results: Out of the 809 patients, 105 (13%) demonstrated 3 out of the 5 criteria for MeS. Based on the MeS criteria, the commonest parameters were abnormal glycaemia (54.1%), followed by visceral obesity (38.6%), raised triglycerides (26.1%), high blood pressure (12.1%), and a low high-density lipoprotein (HDL)-cholesterol (4.6%). The re-assessment of MeS parameters after SVR showed favourable changes, which were statistically significant: a siginficanttly lower serum triglyeride level (182.32 vs. 153.50 mg/dL, P = 0.001), lower systolic arterial blood pressure (130.57 vs. 124.85 mmHg; P = 0.001), lower diastolic arterial blood pressure (80.26 vs. 78.42 mmHg; P = 0.001) and lower glyceamic levels (130.06 vs. 120.71 mg/dL; P = 0.001), as well as a significant rise in HDL-cholesterol levels (48.61 vs. 50.50 mg/dL; P = 0.003). Abdominal circumference was the only parameter, which did not change after SVR. Following the changes sustained after SVR, 26.7% of the patients no longer fulfilled the minimum 3 criteria for MeS. No correlation was observed between the presence of MeS and the risk of severe adverse events, but it was noted that 37.5% of the patients who decompensated, 66.7% of the ones who developed hepatocarcinoma and 100% of the ones that died of abnormal glycaemic levels. Conclusions: Hyperglycemia, and not MeS, is associated with HCV compensated liver cirrhosis genotype 1b, and is a risk factor for severe adverse events. The attainment of SVR through PrOD+R regimen results in short-term improvements in MeS parameters. [ABSTRACT FROM AUTHOR]