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Background <p>Acute variceal bleeding (AVB) continues to carry considerable mortality despite therapeutic advances. Simple, objective prognostic tools are needed for early risk stratification. We evaluated the prognostic performance of the Platelet–Albumin–Bilirubin (PALBI) score compared with the Albumin–Bilirubin (ALBI), Model for End-Stage Liver Disease (MELD), and AIMS65 scores for predicting 5-day, 6-week, and 90-day mortality in cirrhotic patients with AVB.</p> Methods <p>This single-center observational cohort study included consecutive adults with cirrhosis admitted for esophageal variceal AVB at Cho Ray Hospital, Vietnam (October 2021–October 2022). PALBI, ALBI, MELD, and AIMS65 scores were calculated at admission. Primary outcomes were all-cause mortality at 5 days, 6 weeks, and 90 days. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Multivariable logistic regression evaluated independent associations between PALBI and mortality.</p> Results <p>Of 232 patients (mean age 55.0 ± 11.2 years; 78.9% male), 44.4% had alcohol-related cirrhosis and 78.0% were Child–Pugh class B or C. Mortality rates were 3.4% at 5 days, 12.9% at 6 weeks, and 18.9% at 90 days. For 5-day mortality, ALBI (AUC 0.926) performed modestly better than PALBI (AUC 0.902; <i>p</i> = 0.025), though both were excellent. At 6 weeks, PALBI (AUC 0.840) and ALBI (AUC 0.842) performed similarly (<i>p</i> = 0.929), both significantly outperforming MELD and AIMS65 (<i>p</i> &lt; 0.01). A PALBI cut-off of − 1.42 identified 5-day survivors with 100% sensitivity and negative predictive value. PALBI remained an independent predictor of 6-week and 90-day mortality in multivariable models.</p> Conclusion <p>PALBI and ALBI provide superior discrimination for early and mid-term mortality following AVB compared to MELD and AIMS65. Specifically, a PALBI cut-off of − 1.42 reliably rules out 5-day mortality, and cut-offs around − 1.6 identify lower-risk patients at 6 weeks and 90 days, supporting the score's utility for practical risk stratification.</p>

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PALBI score for mortality prediction after variceal bleeding in cirrhosis: performance and comparison with conventional scores

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月9日

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  • Hien Van Pham,
  • Nhan Trung Phan,
  • Phat Tan Ho

摘要

Background

Acute variceal bleeding (AVB) continues to carry considerable mortality despite therapeutic advances. Simple, objective prognostic tools are needed for early risk stratification. We evaluated the prognostic performance of the Platelet–Albumin–Bilirubin (PALBI) score compared with the Albumin–Bilirubin (ALBI), Model for End-Stage Liver Disease (MELD), and AIMS65 scores for predicting 5-day, 6-week, and 90-day mortality in cirrhotic patients with AVB.

Methods

This single-center observational cohort study included consecutive adults with cirrhosis admitted for esophageal variceal AVB at Cho Ray Hospital, Vietnam (October 2021–October 2022). PALBI, ALBI, MELD, and AIMS65 scores were calculated at admission. Primary outcomes were all-cause mortality at 5 days, 6 weeks, and 90 days. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Multivariable logistic regression evaluated independent associations between PALBI and mortality.

Results

Of 232 patients (mean age 55.0 ± 11.2 years; 78.9% male), 44.4% had alcohol-related cirrhosis and 78.0% were Child–Pugh class B or C. Mortality rates were 3.4% at 5 days, 12.9% at 6 weeks, and 18.9% at 90 days. For 5-day mortality, ALBI (AUC 0.926) performed modestly better than PALBI (AUC 0.902; p = 0.025), though both were excellent. At 6 weeks, PALBI (AUC 0.840) and ALBI (AUC 0.842) performed similarly (p = 0.929), both significantly outperforming MELD and AIMS65 (p < 0.01). A PALBI cut-off of − 1.42 identified 5-day survivors with 100% sensitivity and negative predictive value. PALBI remained an independent predictor of 6-week and 90-day mortality in multivariable models.

Conclusion

PALBI and ALBI provide superior discrimination for early and mid-term mortality following AVB compared to MELD and AIMS65. Specifically, a PALBI cut-off of − 1.42 reliably rules out 5-day mortality, and cut-offs around − 1.6 identify lower-risk patients at 6 weeks and 90 days, supporting the score's utility for practical risk stratification.