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5种评分系统对慢加急性肝衰竭患者短期病死率的预测价值
Value of five scoring systems in predicting short-term mortality of patients with acute-on-chronic liver failure
文章发布日期:2019年08月19日  来源:  作者:张静,周新民  点击次数:248次  下载次数:67次

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【摘要】: 目的 应用CTP、MELD、iMELD、CLIF-SOFA和CLIF-C-ACLF评分评估慢加急性肝衰竭(ACLF)患者病情的严重程度,探讨和对比各种评分系统对预测ACLF患者28 d及90 d病死率的应用价值。方法 选择2013年1月-2017年12月西京医院消化内科住院的107例ACLF患者,收集诊断成立时第1天、第3~5天及第7~9天的相关实验室检测指标,分别计算CTP、MELD、iMELD、CLIF-SOFA和CLIF-C-ACLF评分,应用受试者工作特征曲线(ROC曲线)比较以上评分系统的诊断价值。符合正态性的计量资料2组间比较采用t检验或Satterthwaite近似t检验,不符合正态性的计量资料2组间比较采用Man-Whithey U检验;计数资料2组间比较采用χ2检验。结果 在107例患者中,治疗28 d死亡44例(41.1%),治疗90 d死亡55例(51.4%)。诊断成立时iMELD、CLIF-SOFA和MELD评分预测28 d病死率的ROC曲线下面积(AUC)分别为0.81、0.73和0.75,预测患者90 d病死率的AUC分别为0.73、0.68和0.70。诊断成立后第3~5天及7~9天MELD和CLIF-SOFA预测28 d病死率的AUC与iMELD比较差异均无统计意义(Z值分别为0、0.15、3.08、3.11,P值均>0.05),三者预测能力相似;第7~9天MELD和CLIF-SOFA预测90 d病死率的AUC与iMELD比较差异均无统计意义(Z值分别为2.14、1.98,P值均>0.05),三者预测能力相似。iMELD、CLIF-SOFA和MELD评分在诊断成立时、诊断成立后第3~5天及第7~9天的AUC均高于CLIF-C-ACLF和CTP。结论 iMELD是评估ACLF患者病死率的有效预测系统,动态评估iMELD及CLIF-SOFA评分能有效预测ACLF患者的预后。
【Abstract】: Objective To assess the severity of patients with acute-on-chronic liver failure (ACLF) using Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD), integrated MELD (iMELD), Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA), and Chronic Liver Failure-Consortium ACLF (CLIF-C-ACLF) scores, and to investigate the value of these scoring systems in predicting 28- and 90-day mortality rates. Methods A total of 107 patients with ACLF who were hospitalized in Department of Gastroenterology in Xijing hospital from January 2013 to December 2017 were enrolled, and related laboratory markers on days 1, 3-5, and 7-9 after diagnosis were collected. The CTP, MELD, iMELD, CLIF-SOFA, and CLIF-C-ACLF scores were calculated, and the receiver operator characteristic (ROC) curve was used to compare the clinical value of these scoring systems. The t-test or the Satterthwaite t-test was used for comparison of normally distributed continuous data between groups, the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The chi-square test was used for comparison of categorical data between groups. Results Among the 107 patients, 44 (41.1%) died within 28 days and 55 (51.4%) died within 90 days. The scores of iMELD, CLIF-SOFA, and MELD at the time of diagnosis had an area under the ROC curve (AUC) of 0.81, 0.73, and 0.75, respectively, in predicting 28-day mortality, as well as an AUC of 0.73, 0.68, and 0.70, respectively, in predicting 90-day mortality. On days 3-5 and 7-9 after diagnosis, there was no significant difference in the AUC for predicting 28-day mortality between MELD/CLIF-SOFA and iMELD (Z=0, 0.15, 3.08, and 3.11, all P>0.05), suggesting that the three scores had a similar predictive ability; on days 7-9 after diagnosis, there was no significant difference in the AUC for predicting 90-day mortality between MELD/CLIF-SOFA and iMELD (Z=2.14 and 1.98, both P>0.05), suggesting that the three scores had a similar predictive ability. At the time of diagnosis and on days 3-5 and 7-9 after diagnosis, iMELD, CLIF-SOFA, and MELD scores had a significantly higher AUC than CLIF-C-ACLF and CTP scores. Conclusion The iMELD scoring system is proved to be an effective predictive system for short-term mortality in patients with ACLF, and dynamic evaluation of iMELD and CLIF-SOFA scores can effectively predict the prognosis of ACLF patients.
【关键字】:慢加急性肝衰竭; 预后; 对比研究
【Key words】:acute-on-chronic liver failure; prognosis; comparative
【引证本文】:ZHANG J, ZHOU XM. Value of different scoring systems in predicting short-term mortality of patients with acute-on-chronic liver failure[J]. J Clin Hepatol, 2019, 35(9): 1990-1994. (in Chinese)
张静, 周新民. 5种评分系统对慢加急性肝衰竭患者短期病死率的预测价值[J]. 临床肝胆病杂志, 2019, 35(9): 1990-1994.

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