Platelet-Albumin-Bilirubin (PALBI) Score to Predict Outcomes of Acute Variceal Bleed in Patients with Cirrhosis

Abstract

Objective: The objective of this study was to determine whether the Platelet-Albumin-Bilirubin (PALBI) score outperformed the traditional Child-Pugh classification in predicting outcomes, such as deaths in hospitals and
subsequent bleeding, in cirrhotic patients presenting with an acute variceal bleed.
Study Design: A cross-sectional study
Place and Duration of Study: This study was conducted at the Gastroenterology Department, Holy Family Hospital, Rawalpindi from 1 July to 31 December 2021.

Methods: 68 cirrhosis patients who were admitted due to acute variceal bleeding were among them. Serum albumin, bilirubin, and platelet count were used to compute the PALBI score, and the Child-Pugh classification was also evaluated. The two main outcomes were re bleeding within four weeks and in-hospital death. Each scoring system's predictive accuracy was calculated using the Area Under the Receiver Operating Characteristic Curve (AUC).

Results: A total of 68 patients were enrolled in the study, with mean age 54.32 years. 63.2% (43) were male and 36.8% (25) were female. According to Child–Pugh classification, 5.9% were Class A, 27.9% Class B, and 66.2%
Class C. while 14.7% were Grade 1, 38.2% Grade 2, and 47.1% Grade 3 PALBI score. Overall, in-hospital mortality was 16.17%, occurring only in Child–Pugh Classes B (5.26%) and C (22.22%), and in PALBI Grades 2 (7.69%) and
3 (28.13%). No deaths were observed in Child–Pugh A or PALBI Grade 1. Rebleeding occurred in 5.26% of Class B and 57.78% of Class C patients, and in 15.38% of PALBI Grade 2 and 71.88% of Grade 3 patients; no rebleeding
occurred in Class A or PALBI Grade 1. PALBI grade showed a strong association with both mortality and rebleeding (p < 0.001). For predicting rebleeding, PALBI demonstrated high sensitivity (85.19%) and specificity
(100%), with an excellent AUC of 0.926. Although not statistically superior to Child–Pugh (AUC difference 0.0944; p = 0.0722), PALBI showed better overall performance.

Conclusion: When predicting rebleeding and early mortality in individuals with acute variceal hemorrhage, the PALBI score is a trustworthy method.