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. 2020 Nov 16;20(1):381.
doi: 10.1186/s12876-020-01522-6.

High-density lipoprotein cholesterol is a predictor of survival in cirrhotic patients with acute gastrointestinal bleeding: a retrospective study

Ran Cheng  1 , Ning Tan  1 , Qian Kang  1 , Hao Luo  1 , Hongyu Chen  1 , Jiali Pan  1 , Yifan Han  1 , Yuqing Yang  1 , Xiaoyuan Xu  2
Affiliations

High-density lipoprotein cholesterol is a predictor of survival in cirrhotic patients with acute gastrointestinal bleeding: a retrospective study

Ran Cheng et al. BMC Gastroenterol. .

Abstract

Background: Lipid profiles are declined in patients with viral liver cirrhosis and correlated with severity of liver disease. Hepatitis B virus (HBV) is the leading cause of liver cirrhosis in China. Our primary aim was to investigate whether serum lipids and lipoproteins associate with survival in patients with HBV-related cirrhosis and acute gastrointestinal bleeding, and develop a 6-week mortality risk score that incorporates it.

Methods: From January 2008 to December 2015, consecutive cirrhotic patients with acute gastrointestinal bleeding admitted to our hospital were evaluated and randomly divided into the derivation (n = 629) and validation (n = 314) cohorts. A logistic regression model was established to confirm the association between lipoprotein cholesterol and mortality. Accuracy to predict mortality were assessed by area under the receiver operating characteristic curves (AUROCs) and compared using the Hanley and McNeil test.

Results: Among study subjects, the 6-week mortality rate was 10.6%. High-density lipoprotein cholesterol (HDL-C) level was found to correlate most strongly with prognostic scores. On ROC analysis, HDL-C showed excellent diagnostic accuracy for 6-week mortality. Logistic regression analysis provided a simple algorithm based on the combined use of 4 variables (total bilirubin (TBIL), HDL-C, International normalized ratio, and hemoglobin), allowing accurate discrimination of 3 distinct prognostic subgroups with 1.7% (low risk), 12.3% (intermediate risk), and 56.9% (high risk) mortality. Its accuracy was significantly better than that of Child-Pugh, model of end-stage liver disease, albumin-bilirubin score, D'Amico model, Augustin model, AIMS65 score and Glasgow-Blatchford score. Baseline HDL-C values ≤ 0.54 mmol/L were associated with markedly lower 6-week survival. Comparable results were found in the validation set.

Conclusion: HDL-C is a potential indicator for the prognosis of patients with cirrhosis and acute gastrointestinal bleeding. The new algorithm based on HDL-C allowed an accurate predictive assessment of 6-week mortality after bleeding attack.

Keywords: 6-Week mortality; Acute gastrointestinal bleeding; High-density lipoprotein cholesterol; Liver cirrhosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Comparison of predictive performance of N-CGIB score with Child–Pugh, MELD, ALBI, D’Amico, Augustin model, AIMS65 score, and Glasgow-Blatchford score in the derivation cohort (a) and validation cohort (b)
Fig. 2
Fig. 2
Probability of 6-week survival in cirrhotic patients with acute gastrointestinal bleeding according to the developed model in the derivation and validation sets. N-CGIB identified 3 risk groups: low-risk (< -3), medium-risk (−3 to −1), high-risk (> −1). The probability of survival progressively and significantly decreased across groups, both in the derivation (A) and validation (b) sets (P < 0.001)
Fig. 3
Fig. 3
Mortality was significantly higher in patients with HDL-C ≤ 0.54 mmol/L (P < 0.001 by log-rank test) in the derivation (a) and validation (b) sets
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