PREDICTIVE VALUE OF THE MAP(ASH) AND ABC SCORES FOR MORTALITY AND EARLY REBLEEDING IN CIRRHOTIC PATIENTS WITH GASTROINTESTINAL BLEEDING DUE TO RUPTURED ESOPHAGEAL VARICES
Main Article Content
Abstract
Background: To minimize risks and personalize management protocols for cirrhotic patients with esophageal variceal bleeding, predicting clinical outcomes and assessing disease severity are of core significance. Objective: To investigate the characteristics of clinical outcomes, the association according to risk stratification, and compare the predictive values of the MAP(ASH) and ABC scoring systems for mortality and early rebleeding risks in cirrhotic patients with gastrointestinal bleeding due to esophageal varices. Materials and methods: Using a cross-sectional descriptive study design, data were collected and analyzed from 170 cases of liver cirrhosis with bleeding due to ruptured esophageal varices, receiving inpatient treatment at Can Tho Central General Hospital. Results: The rates of mortality and early rebleeding events in the study sample were 8.2% and 9.4%, respectively. Regarding the capability to predict mortality, both tools demonstrated excellent predictive values, with the area under the curve (AUC) of MAP(ASH) reaching 0.892 (95% CI: 0.826 – 0.959) and that of ABC reaching 0.874 (95% CI: 0.808 – 0.940), with p < 0.001 for both scores in predicting mortality. The DeLong test indicated that the predictive performances of these two scoring systems were comparable (p = 0.638). At the cut-off threshold of 5, MAP(ASH) achieved a sensitivity (Se) of 92.9% and a specificity (Sp) of 71.8%; whereas ABC at the cut-off threshold of 7 recorded a Se of 92.9% and a Sp of 74.4%. Notably, in assessing the risk of rebleeding, MAP(ASH) demonstrated superior performance compared to ABC (AUC: 0.788 (0.697 - 0.879) vs. 0.671 (0.530 - 0.812)), with a statistically significant difference (p = 0.044). Conclusion: Both scoring systems have high reliability in predicting mortality. However, the MAP(ASH) score is more sensitive in forecasting the risk of early clinical rebleeding but carries a higher risk of false positives compared to the ABC score.
Keywords
MAP(ASH), ABC, cirrhosis, rebleeding, mortality
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References
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