Abstract
Introduction. Liver cirrhosis is a chronic condition associated with severe complications, including esophageal variceal bleeding, which carries high morbidity and mortality rates. Approximately 60% of patients with cirrhosis experience recurrent bleeding within one year, with a mortality rate of 20–60% within six weeks after the initial bleeding episode. Therefore, identifying predictors of recurrent bleeding is essential for improving preventive strategies. This study aimed to identify predictors of recurrent esophageal variceal bleeding in patients with liver cirrhosis and to develop a predictive model.
Methods. This retrospective study included 220 patients with liver cirrhosis and a history of esophageal variceal bleeding based on medical record data. The variables analyzed included age, platelet count, red color sign, spontaneous bacterial peritonitis, splenomegaly, number of endoscopic variceal ligation (EVL) bands, portal hypertensive gastropathy, and Child–Pugh score. Statistical analyses were performed to identify independent predictors and to develop a prediction model.
Results. Recurrent esophageal variceal bleeding occurred in 33.6% of patients. Patients with recurrent bleeding were more likely to be male, younger, have hepatitis B as the underlying etiology, a Child–Pugh score ≥7, a platelet count <150,000/µL, and ≥3 EVL bands placed during treatment. Bivariate analysis demonstrated that a Child–Pugh score ≥7, platelet count <150,000/µL, ≥3 EVL bands, the presence of a red color sign, and splenomegaly were significantly associated with recurrent esophageal variceal bleeding in patients with liver cirrhosis. The final prediction model consisted of three variables: Child–Pugh score, platelet count, and number of EVL bands, with a maximum total score of 4 points. The model demonstrated good predictive performance, with an area under the receiver operating characteristic curve (AUC) of 0.81.
Conclusions. The predictors of recurrent esophageal variceal bleeding in patients with liver cirrhosis were Child–Pugh score, platelet count, and the number of EVL bands. The resulting prediction model demonstrated good statistical performance and may be useful for risk stratification in clinical practice.
Bahasa Abstract
Pendahuluan. Sirosis hati adalah kondisi kronik yang berujung pada komplikasi berat seperti perdarahan varises esofagus yang memiliki angka kejadian dan mortalitas tinggi. Sekitar 60% pasien sirosis mengalami perdarahan ulang dalam satu tahun dengan tingkat kematian 20-60% dalam 6 minggu setelah perdarahan. Oleh karena itu, penting untuk mengidentifikasi faktor-faktor prediktor guna mencegah perdarahan berulang. Penelitian ini bertujuan untuk mengidentifikasi faktor prediktor kejadian perdarahan varises esofagus berulang pada pasien sirosis hati serta membuat model prediksinya.
Metode. Penelitian ini melibatkan 220 pasien sirosis hati dengan riwayat perdarahan varises esofagus berdasarkan data rekam medis. Variabel yang dianalisis meliputi usia, jumlah trombosit, red colour sign, spontaneous bacterial peritonitis, splenomegali, jumlah ligasi, gastropati hipertensi portal, dan skor Child-Pugh. Analisis dilakukan untuk mengidentifikasi faktor prediktor dan membangun model prediksi.
Hasil. Perdarahan varises esofagus berulang terjadi pada 33,6% pasien. Kelompok dengan perdarahan berulang lebih banyak ditemukan pada laki-laki, usia lebih muda, etiologi hepatitis B, skor Child-Pugh ≥7, jumlah trombosit <150.000/µL, dan jumlah ligasi ≥ 3 buah. Analisis bivariat mendapatkan skor Child-Pugh ≥ 7, jumlah trombosit < 150.000/µL, jumlah ligasi ≥3 buah, adanya red colour sign, dan splenomegali memengaruhi terjadinya perdarahan varises esofagus berulang pada pasien sirosis hati. Model prediksi akhir terdiri atas 3 variabel, yaitu skor Child-Pugh, jumlah trombosit, dan jumlah ligasi dengan total skor 4 poin. Model prediksi ini menunjukkan performa prediksi yang baik dengan nilai area under the curve (AUC) 0,81.
Kesimpulan. Variabel prediktor terjadinya perdarahan varises esofagus berulang pada pasien sirosis hati adalah skor Child Pugh, jumlah trombosit, dan jumlah ligasi dengan model prediksi performa statistik yang tinggi.
Kata Kunci: model prediksi, perdarahan varises esofagus berulang, sirosis hati
Recommended Citation
Sari, Ifani Media; Kurniawan, Juferdy; Kalista, Kemal Fariz; Rizka, Aulia; Ginanjar, Eka; Nasution, Sally Aman; Nainggolan, Leonard MD. Internal medicine, Tropic-Infection spesialist; and Koesnoe, Sukamto
(2026)
"Variabel dan Model Prediktor Perdarahan Varises Esofagus Berulang pada Pasien Sirosis Hati di RSUPN Dr. Cipto Mangunkusumo,"
Jurnal Penyakit Dalam Indonesia: Vol. 13:
Iss.
2, Article 1.
DOI: 10.7454/jpdi.v13i2.1825
Available at:
https://scholarhub.ui.ac.id/jpdi/vol13/iss2/1
