The prognostic value of the INR-to-platelet ratio for predicting rebleeding and mortality following endoscopic band ligation: A multicenter retrospective study
Abstract
Objective: Esophageal variceal bleeding is one of the most severe complications of cirrhosis and is associated with a high risk of rebleeding and mortality. This study aimed to evaluate the prognostic value of the international normalized ratio–to–platelet ratio (INR/PLT) in predicting six-month rebleeding and mortality after endoscopic variceal ligation (EVL).
Materials and Methods: In this retrospective multicenter study, 85 cirrhotic patients who underwent EVL for esophageal variceal bleeding between February 2022 and September 2024 were analyzed. Demographic data, clinical characteristics, and laboratory parameters at admission were recorded. Child–Pugh and Model for End-Stage Liver Disease–Sodium (MELD-Na) scores were calculated. The INR/PLT ratio was derived from admission INR and platelet values. The primary endpoints were six-month rebleeding and all-cause mortality.
Results: The median age was 63 (26–85) years, and 34.1% were female. Within six months, mortality occurred in 18 patients (21.2%), and rebleeding developed in 15 patients (17.6%). Patients who died had significantly higher MELD-Na scores (23.5 vs. 11; p<0.001). The presence of AKI (55.6% vs. 9.0%; p<0.001), lower albumin levels (p<0.001), and higher creatinine levels (p<0.001) were associated with mortality. The INR/PLT ratio was not significantly associated with mortality (p=0.739) or rebleeding (p=0.209) and was not identified as an independent predictor in multivariable analyses.
Conclusion: Six-month outcomes after esophageal variceal bleeding appear to be primarily determined by hepatic reserve and renal dysfunction rather than simple hematologic ratios. The INR/PLT ratio did not demonstrate clinical utility in predicting rebleeding or mortality in this cohort. Parameters reflecting AKI dysfunction may be more appropriate for risk stratification.
Keywords
Esophageal variceal bleeding, INR-to-platelet ratio, MELD-Na, Acute Kidney Injury, mortality, rebleeding
Supporting Institution
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Ethical Statement
Ethics committee approval was obtained from the Aksaray University Scientific Research Ethics Committee (Decision No: 2026/28; Protocol No: SAGETIK 2025-150; Date: 05 February 2026). The study was conducted in accordance with the ethical principles of the Declaration of Helsinki.
Thanks
The authors thank Hanife Uzar for valuable contributions to the statistical analysis. Artificial intelligence–assisted technologies (ChatGPT, OpenAI, San Francisco, CA, USA) were used for English language editing and improving academic clarity. The final content was reviewed and approved by all authors.
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