Abstract: Objective The aim of this study was to investigate prediction of re-bleeding by platelet-to-albumin ratio (PAR) and Charlson comorbidity indexin cirrhotics with esophageal variceal bleeding (EVB) after first hemostasis. Methods 119 patients with EVB arisen from liver cirrhosiswere encountered in our hospital between May 2021 and June 2024, all received somatostatin and omeprazole therapy for emergent hemostasis at base of comprehensive supporting measurement and oral carvedilol maintenance thereafter, and were followed-up for six months. PAR and Charlson index were routinely obtained clinically, and hepatic vein pressure gradient (HVPG) was detected and calculated by Siremuller special equipment. Multivariate Logistic regression analysis was conducted to screen risk factors for re-bleeding, and receiver operating characteristic curve (ROC) was applied to analyze predicting performance. Results By end of 6 months, re-bleeding occurred in 41cases (34.5%) out of the 119 patients; platelet count and PAR in the re-bleeding group were (53.4±5.6)×10⁹/L and (1.8±0.2), both much lower than [(68.9±7.3)×10⁹/L and (2.3±0.4),P<0.05], while serum D-dimer, Charlson index, HVPG, portal vein diameter, splenic vein diameter and percentage of G3 EV were (2.7±0.3)g/L, (2.6±0.3),(20.3±2.6)mmHg, (16.3±1.7)mm,(10.5±1.4)mm and 78.0%, all significantly higher than [(1.4±0.2)g/L, (2.0±0.4),(16.2±1.8)mmHg, (14.6±1.8)mm, (8.8±0.9)mm and 42.3%, respectively, P<0.05] in non-re-bleeding group; Logistic regression analysis showed that PAR was protecting factor (OR=0.562, 95%CI:0.397-0.797,P<0.05), while Charlson index (OR=1.587, 95%CI: 1.064-2.368),HVPG(OR=1.464, 95%CI:1.072-1.999)and EV grading (OR=1.647, 95%CI:1.041-2.606, P<0.05) were all the independent risk factors;ROC analysis demonstrated that the AUC was 0.889(95%CI:0.838-0.939) when PAR was combined Charlson index in predicting re-bleeding, much superior to PAR[AUC=0.804(95%CI:0.747-0.861) by PAR or Charlson index [AUC=0.790(95%CI:0.725-0.855), P<0.05] alone. Conclusion The combination of PAR and Charlson index has to some extent predicting performance of re-bleeding in patients with EVB after first hemostasis.

Key words: Liver cirrhosis, Esophageal varicealbleeding, Platelet-to-albumin ratio, Charlson index, due, Re-bleeding, Prediction