Value of five-stage prognostic system in predicting short-term outcome of patients with liver cirrhosis
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摘要: 目的评价5期-预后系统(简称5期系统)在预测肝硬化患者短期预后中的临床价值并与Child-Turcotte-Pugh(CTP)、终末期肝病模型(MELD)评分进行比较。方法收集2011年1月至2014年1月安徽医科大学第一附属医院消化科符合研究标准并随访6个月的201例肝硬化住院患者临床预后资料,依据肝硬化5期系统对所有纳入研究的患者进行分期,计算各期病死率。应用受试者特征(ROC)曲线及曲线下面积(AUC)评价5期系统判断肝硬化患者短期死亡风险的准确性并与CTP、MELD评分进行比较。计数资料比较采用χ2检验,并应用Cox回归分析肝硬化患者预后的高危因素。AUC的比较采用正态性Z检验,5期系统与CTP及MELD评分的相关性分析采用Spearman相关分析。结果以入院时间为研究起点,死亡或研究终止时间为终点。201例肝硬化患者6个月病死率为24.9%(50/201),依据5期系统计算15期病死率分别为0(0/11)、0(0/18)、4.2%(2/48)、16.3%(7/43)及50.6%(41/81),对于失代偿期肝硬化(3、4、5期)病死率随分期级别的升高而增加...Abstract: Objective To evaluate the clinical value of five- stage prognostic system in predicting the short- term outcome of patients with liver cirrhosis,and to compare it with the Child- Turcotte- Pugh( CTP) and Model of End- Stage Liver Disease( MELD) scores. Methods Two hundred and one hospitalized patients with liver cirrhosis in the Department of Gastroenterology in the First Affiliated Hospital of Anhui Medical University from January 2011 to January 2014 were enrolled in the study and followed up for at least six months. Patients were classified accorded to the five- stage prognostic system,and the mortality rate in each stage was measured. The receiver operating characteristic( ROC) curve and the area under the ROC curve( AUC) were used to assess the accuracy of the five- stage prognostic system in predicting the short- term death risk of cirrhotic patients,which was then compared with the CTP and MELD scores. Categorical data were analyzed by chi- square test. Comparison of AUC was made by normal distribution Z test. Spearman's correlation analysis was used to investigate the correlation of the five- stage prognostic system with the CTP and MELD scores. Results The study used the admission time as the starting point and the death of patients or study termination time as the endpoint. Among the 201 patients,50( 24. 9%) died within six months. Based on the five- stage prognostic system,the mortality rates for stages 1 to 5 were 0( 0 /11),0( 0 /18),4. 2%( 2 /48),16. 3%( 7 /43),and 50. 6%( 41 /81),respectively. In patients with decompensated cirrhosis( stages 3,4,and 5),the mortality increased with stage,and the differences in mortality between patients in stages 3 and 4,3 and 5,and 4 and 5 were all significant( χ2= 3. 89,35. 33,and13. 96,respectively; P = 0. 049,0. 000,and 0. 049,respectively). The AUC for the five- stage prognostic system,five- stage prognostic system combined with CTP and MELD score,and CTP score were 0. 820,0. 915,0. 888,and 0. 809,respectively( P < 0. 05). The five-stage prognostic system showed positive correlations with both CTP and MELD scores( r = 0. 772,P = 0. 000; r = 0. 479,P = 0. 000). Conclusion The five- stage prognostic system based on portal hypertension complications is effective in predicting the short- term outcome of patients with decompensated liver cirrhosis. A combination of the five- stage prognostic system and the CTP and MELD scores can accurately predict the outcome of patients with liver cirrhosis.
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Key words:
- liver cirrhosis /
- prognosis /
- factor analysis,statistical
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