Platelet count combined with Child-Turcotte-Pugh score for predicting rebleeding in cirrhotic patients with esophagogastric variceal bleeding

Abstract

To investigate the predictive value of platelet count (PLT) combined with the Child-Turcotte-Pugh (CTP) score for rebleeding in cirrhotic patients with esophagogastric variceal bleeding (EGVB). This single-center retrospective study included 332 eligible patients selected from 375 consecutive patients with cirrhosis and EGVB. Patients were categorized into rebleeding and non-rebleeding groups according to the occurrence of rebleeding between 5 days and 6 weeks after initial hemostasis. Cox proportional hazards regression, Kaplan–Meier survival, and receiver operating characteristic curve analyses were performed to identify independent predictors of rebleeding and evaluate the predictive value of PLT, total bilirubin (TBil), albumin (ALB), CTP score, Model for End-Stage Liver Disease (MELD) score, and their combined models. Patients who experienced rebleeding exhibited higher frequencies of hematemesis and melena, more severe esophageal varices, a greater prevalence of gastroesophageal varices type 2 (GOV2), elevated levels of TBil, creatinine, prothrombin time, CTP, and MELD scores, and lower ALB and PLT. Elevated TBil and reduced PLT and ALB levels were independent factors associated with an increased risk of rebleeding. The combined PLT–CTP model achieved an area under the curve of 0.859, with a sensitivity of 81.25% and specificity of 76.27% for predicting rebleeding, superior to that of individual indicators and the PLT–MELD model. Elevated TBil and decreased PLT and ALB are independent predictors of rebleeding in cirrhotic patients with EGVB. A predictive model combining PLT and CTP scores provides a practical tool for bedside risk stratification and rebleeding prediction, thereby facilitating individualized monitoring and therapeutic decision-making.