Abstract: Objective To explore the prognostic value of PALBI combined with AMIS65 scoring system in cirrhotic patients with acute upper gastrointestinal bleeding.Methods A total of 230 patients with cirrhosis complicated with acute upper gastrointestinal bleeding admitted from September 2017 to March 2021 were selected. According to 30 days’ survival status after admission the patients were divided into a survival group (N=201) and a death group (N=29). Epidemiological data including age and sex, and laboratory examination Results including routine blood test, hepatic and renal function, and coagulation function were collected and compared, The scores of PALBI and AMIS65 on admission were calculated and compared between the two groups. Single factor analysis and logistic regression analysis based on partial maximum likelihood estimation were used to determine the independent influencing factors of prognosis, and the receiver operating characteristic (ROC) curve was used to evaluate the value of individual and combined detection in predicting death.Results Prothrombin time (21.64 ± 2.97 vs 20.12 ± 2.68, t=2.816, P=0.005), total bilirubin (34.76 ± 2.78 vs 26.87 ± 3.02, t=13.277, P<0.001), international standardized ratio (1.55 ± 0.21 vs 1.33 ± 0.38, t=4.649, P<0.001), PALBI score (-1.43 ± 0.31 vs -1.94 ± 0.26, t = 9.629, P<0.001) and AMIS65 scores (3.45 ± 0.58 vs 2.09 ± 0.41, t=12.195, P<0.001) in the death group were significantly higher than those of the survival group. Albumin (27.54 ± 6.01 vs 31.98 ± 5.01, t=4.346, P<0.001) and platelet count (71.99 ± 18.23 vs 83.56 ± 24.25,t=1.829, P=0.049) and Child-Pugh grade A ratio (3.45% vs 33.83%, χ² = 26.117, P<0.001) in the death group were significantly lower than those in the survival group. Logistic regression analysis showed that PALBI score (OR=1.597, 95%CI: 1.597~2.449) and AMIS65 score (OR=2.162, 95%CI: 1.499~3.357) were independent factors affecting the prognosis of acute upper digestive tract bleeding in cirrhosis, and the equation was logit (P)=-0.541+0.682XPALBI score +0.771XAMIS65 score. ROC curve analysis showed that PALBI score alone predicted the optimal critical value was -1.69 score, with a corresponding sensitivity of 79.31%, specificity of 80.60%, and AUC of 0.801 (95%CI: 0.750~0.852). The predictive optimal critical value of AMIS65 score alone was 2.73 score, with a corresponding sensitivity of 65.52%, specificity of 62.69%, and AUC of 0.760 (95%CI: 0.707~0.812). The sensitivity, specificity and AUC corresponding to the optimal truncation value of regression combined detection were 96.55%, 95.52% and 0.975 (95%CI: 0.924~0.986) respectively, and the sensitivity, specificity and AUC of combined prediction were significantly higher than those of PALBI score and AMIS65 score alone (P<0.05), which showed certain predictive value.Conclusion PALBI score and AMIS65 score were independent factors affecting the prognosis of acute upper digestive tract in cirrhosis, and regression analysis combined with detection had higher predictive value.

Key words: Platelet-albumin-bilirubin score, AMIS65 score, Liver cirrhosis, Acute upper gastrointestinal bleeding, Prognosis