{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T12:58:56Z","timestamp":1792155536563,"version":"4.4.0"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,10,3]],"date-time":"2019-10-03T00:00:00Z","timestamp":1570060800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,10,3]],"date-time":"2019-10-03T00:00:00Z","timestamp":1570060800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2019,10,3]],"date-time":"2019-10-03T00:00:00Z","timestamp":1570060800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>There currently is no consensus on how to accurately predict early rebleeding and death after a major variceal bleed. This study investigated the relative predictive performances of the original Child\u2013Pugh (CP), model for end\u2010stage liver disease (MELD) and a four\u2010category recalibrated Child\u2013Pugh (rCP).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This prospective study included all adult patients admitted to Groote Schuur Hospital with acute esophageal variceal bleeding secondary to alcoholic cirrhosis, between January 2000 and December 2017. CP and rCP grades and MELD score were calculated on admission, and the predictive ability in discriminating in\u2010hospital rebleeding and death was compared by area under receiver\u2010operating characteristic (AUROC) curves.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the study period, 403 consecutive adult patients were treated for bleeding esophageal varices of whom 225 were secondary to alcoholic cirrhosis. Twenty\u2010four (10.6%) patients were CP grade A, 88 (39.1%) grade B and 113 (50.2%) grade C on hospital admission. MELD scores ranged from 6 to 40. Thirty\u2010one (13.8%) patients rebleed, and 41 (18.2%) patients died. There was no difference in the discriminatory capacity of the CP (AUROC 0.59, 95% CI 0.50\u20130.670) and MELD (AUROC 0.62, 95% CI 0.51\u20130.73) to predict rebleeding (<jats:italic>p<\/jats:italic>\u2009=\u20090.72), or between the Child\u2013Pugh (AUROC 0.75, 95% CI 0.71\u20130.81) and MELD (AUROC 0.71, 95% CI 0.62\u20130.80) to predict death (<jats:italic>p<\/jats:italic>\u2009=\u20090.35). The rCP classification (A\u2013D) had a significantly improved discriminatory capacity (AUROC 0.83 95% CI 0.77\u20130.89) compared to the CP score (A\u2013C) and MELD to predict death (<jats:italic>p<\/jats:italic>\u2009=\u20090.004).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A recalibrated Child\u2013Pugh score outperforms the original Child\u2013Pugh grade and MELD score in predicting in\u2010hospital death in patients with bleeding esophageal varices secondary to alcoholic cirrhosis.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-019-05211-8","type":"journal-article","created":{"date-parts":[[2019,10,3]],"date-time":"2019-10-03T18:09:40Z","timestamp":1570126180000},"page":"241-246","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["A New Recalibrated Four\u2010Category Child\u2013Pugh Score Performs Better than the Original Child\u2013Pugh and MELD Scores in Predicting In\u2010Hospital Mortality in Decompensated Alcoholic Cirrhotic Patients with Acute Variceal Bleeding: a Real\u2010World Cohort Analysis"],"prefix":"10.1002","volume":"44","author":[{"given":"Jake","family":"Krige","sequence":"first","affiliation":[{"name":"Department of Surgery, J45 OMB University of Cape Town Health Sciences Faculty Anzio Road, Observatory 7925 Cape Town South Africa"},{"name":"Surgical Gastroenterology and HPB Unit Groote Schuur Hospital Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard T.","family":"Spence","sequence":"additional","affiliation":[{"name":"Department of Surgery, J45 OMB University of Cape Town Health Sciences Faculty Anzio Road, Observatory 7925 Cape Town South Africa"},{"name":"Department of Surgery Dalhousie University 1276 South Park Street B3H 2Y9 Halifax NS Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduard","family":"Jonas","sequence":"additional","affiliation":[{"name":"Department of Surgery, J45 OMB University of Cape Town Health Sciences Faculty Anzio Road, Observatory 7925 Cape Town South Africa"},{"name":"Surgical Gastroenterology and HPB Unit Groote Schuur Hospital Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marius","family":"Hoogerboord","sequence":"additional","affiliation":[{"name":"Department of Surgery Dalhousie University 1276 South Park Street B3H 2Y9 Halifax NS Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Ellsmere","sequence":"additional","affiliation":[{"name":"Department of Surgery Dalhousie University 1276 South Park Street B3H 2Y9 Halifax NS Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,10,3]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0901512"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072\u2010017\u20109804\u20103"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.05.022"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.4254\/wjh.v2.i7.261"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.313"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2011.173"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000000733"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2004.06.005"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/he.2000.5852"},{"key":"e_1_2_8_11_1","first-page":"50","volume-title":"The liver and portal hypertension","author":"Child CG","year":"1964"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800600817"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1155\/2011\/678050"},{"key":"e_1_2_8_14_1","first-page":"84","article-title":"Factors associated with waiting time on the liver transplant list: an analysis of the United Network for Organ Sharing (UNOS) database","volume":"31","author":"Trieu JA","year":"2018","journal-title":"Ann Gastroenterol"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000231704.45005.4e"},{"key":"e_1_2_8_16_1","unstructured":"KrigeJEJ BeningfieldSJ(2018)Endoscopic therapy in the management of esophageal varices: injection sclerotherapy and variceal ligation. 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