The prognostic value of DIC score combined with lactate in patients with cirrhosis complicated by variceal upper gastrointestinal bleeding: a single-center retrospective cohort study

Abstract

Objective This study aimed to investigate the predictive value of the disseminated intravascular coagulation (DIC) score combined with lactate (Lac) for the prognosis of patients with cirrhosis and variceal upper gastrointestinal bleeding (VUGIB). Methods In this retrospective cohort study, we enrolled 409 patients with liver cirrhosis and VUGIB who were admitted to Beijing You'an Hospital, Capital Medical University, between July 2023 and July 2025.The predictive outcomes were 28-day mortality, multiple organ dysfunction syndrome (MODS), and admission to the intensive care unit (ICU). Univariate baseline comparisons were performed. A multivariable logistic primary model was constructed, and two types of sensitivity analyses were established. The independence of the DIC score as a prognostic factor was assessed using Wald, likelihood-ratio, and interaction tests. Receiver operating characteristic (ROC) curves were plotted, and the areas under the curves (AUCs) of the models were compared using DeLong's test. Internal validation was conducted with 1,000 bootstrap resamples. Model calibration was evaluated using the Hosmer-Lemeshow test and calibration curves. The optimal cut-off value was determined via 10-fold cross-validation, and survival differences were analyzed using the Kaplan–Meier method. Decision curve analysis was performed to evaluate the net clinical benefit. Results Univariate analysis revealed that lactate, DIC score, and various liver function and bleeding scores differed significantly among the three prognostic outcome groups (all P < 0.05). After adjusting for covariates, DIC score was identified as an independent risk factor for all three outcomes, and its predictive value was independent of Child-Pugh and MELD-Na scores, with no interaction between them. ROC analysis showed that the combined lactate + DIC model had the best discriminative performance (AUC for mortality = 0.892, for MODS = 0.889, for ICU admission = 0.851), and DeLong's test confirmed that it was superior to most conventional scores. After bootstrap correction, the model exhibited no significant optimism bias, and the Hosmer-Lemeshow test indicated good calibration. Stratification by the cross-validation-derived cutoff value revealed statistically significant differences in 28-day survival between high-and low-risk patients across all outcome groups (log-rank P < 0.001). Decision curve analysis demonstrated that the lactate + DIC model provided higher net clinical benefit than DIC score alone.   Conclusion The combination of DIC score and lactate independently predicts the risks of 28-day mortality, MODS, and ICU admission in patients with liver cirrhosis and VUGIB. Multidimensional validation demonstrated that this model exhibited superior discrimination, calibration, and net clinical benefit compared with any single score, and thus can be applied for early risk stratification at admission.