ACCURACY OF ROCKALL SCORE FOR IN HOSPITAL RE-BLEEDING AMONG CIRRHOTIC PATIENTS WITH VARI-CEAL BLEED

Abstract

Abstract

Objective:  To assess the diagnostic accuracy of Roc-kall scoring system for predicting in-hospital re-ble-eding in cirrhotic patients presenting with variceal bleed.

Material and Methods:  This descriptive case series study was conducted at Department of Medicine Com-bined Military Hospital Lahore from December 2013 to May 2014. We included patients with liver cirrhosis who presented with upper GI bleeding and showed varices as the cause of bleeding on endoscopy. Clini-cal and endoscopic features were noted to calculate Rockall score. Patients with score of ≤ 2 and ≥ 8 were included. After treating with appropriate pharmacolo-gical and endoscopic therapy, patients were followed for re-bleeding for 10 days. Diagnostic accuracy was

Asgher S.A.¹

Assistant Professor of Medicine

CMH LHR Medical College, Combined Military Hospital, Lahore

Saleem M.K.²

Assistant Professor of Medicine

CMH LHR Medical College, Combined Military Hospital, Lahore

Hussain A.³

Associate Professor of Medicine

SIMS / Services Hospital, Lahore

assessed by calculating sensitivity, specificity, positive and negative predictive values using 2 × 2 tables.

Results:  In the study, 175 patients were included. Mean age was 51.5 ± 1.22 years. Male to female ratio was 1.5 to 1.Out of 175 patients, 157 patients (89.7%) were of low risk group (score ≤ 2) while 18 patients (10.3%) were in high risk group (score ≥ 8). In low risk group, re-bleeding occurred only in 2 patients (1.2%) while in high risk group, re-bleeding occurred in 14 patients (78%). Rockall score was found to have good diagnostic accuracy with sensitivity of 87.5%, specificity of 97.48%, positive predictive value of 77.8% and negative predictive value of 98.7%.

Conclusion:  In cases of variceal bleed, frequency of re-bleed is less in patients who are in low risk category with lower Rockall score and high in high risk patients with higher rockall score. The Rockall score has a good diagnostic accuracy in prediction of re-bleed in variceal bleeding.

Key Words:  Upper Gastrointestinal (GI) Bleed, Roc-kall Score, Re-bleed in varices.