十一种临床评分预测肝硬化伴急性上消化道出血6周死亡风险

目的 判断常用的十一种临床评分对肝硬化伴急性上消化道出血患者6周死亡风险的预测能力。方法 收集2013年至2020年在上海交通大学医学院附属瑞金医院消化内科住院的肝硬化伴急性上消化道出血患者，并绘制ROC曲线判断不同模型或评分的预判能力。结果 共645例患者入组，未经倾向匹配评分(propensity score matching, PSM)的原始数据提示十一种评分方法只有谷草/谷丙转氨酶比值(aspartate/alanine aminotransferase ratio, AAR)不能很好地区分6周内发生死亡风险的患者(P=0.2)。经PSM匹配后数据提示Lok评分、NLR、Child-Pugh评分、MELD评分、白蛋白-胆红素评分(albumin-bilirubin score, ALBI)、血小板-白蛋白-胆红素评分(platelet-albumin-bilirubin score, PALBI)均可用于预测6周死亡风险(P<0.05)。结论 Child-Pugh评分、MELD评分、NLR、Lok评分、ALBI和PALBI在预测肝硬化伴急性上消化道出血患者6周死亡风险有较...     

PALBI评分对肝硬化合并急性上消化道出血患者短期预后的预测价值

目的评估血小板-白蛋白-胆红素评分(PALBI)对肝硬化合并急性上消化道出血患者30 d内死亡的预测价值。方法回顾性收集2016年1月—2020年2月在复旦大学附属金山医院因急性上消化道出血入院的211例肝硬化患者,根据30 d内生存情况分为死亡组(n=24)和生存组(n=187),收集患者的流行病学资料(年龄、性别等)和实验室检查资料(血常规、肝肾功能、凝血功能等),计算入院时的PALBI、ALBI、CTP和MELD评分,比较两组间评分是否存在差异。计量资料两组间比较采用t检验;计数资料两组间比较采用χ~2检验。通过受试者工作特征曲线(ROC曲线)及曲线下面积(AUC)衡量模型的预测能力。AUC的比较采用DeLong检验。结果死亡组PALBI、ALBI、CTP和MELD评分分别为-1.47±0.35、-0.74±0.49、10.25±1.98、17.25±4.68,生存组PALBI、ALBI、CTP和MELD分值分别为-1.94±0.36、-1.38±0.51、8.06±1.70、11.63±4.83,死亡组各项评分均明显高于生存组(P值均0.001)。PALBI、ALBI、CTP和MELD评分的ROC曲线下面积分别为0.827、0.824、0.790、0.811,AUC两两比较差异均无统计学意义(P值均0.05)。结论 PALBI评分对肝硬化合并急性上消化道出血30 d内死亡的预测表现良好,与CTP和MELD评分相当。     

Rockall积分干预对肝硬化急性上消化道出血患者康复治疗的影响

目的:探究Rockall积分干预在肝硬化急性上消化道出血患者康复治疗中的应用效果。方法:选取我院2016年2月至2017年2月收治的采用常规干预的肝硬化急性上消化道出血患者55例作为对照组,另选取我院2017年3月至2018年3月收治的采用Rockall积分量表干预的肝硬化急性上消化道出血患者55例作为观察组。对比两组患者不良事件发生率、生活质量及满意度。结果:观察组患者再出血率及死亡率均低于对照组,差异有统计学意义(P0.05);观察组患者干预3个月后生理、心理、环境、独立性、精神支柱、社会关系评分均高于对照组,差异有统计学意义(P0.05);观察组患者满意度高于对照组,差异有统计学意义(P0.05)。结论:Rockall积分干预应用于肝硬化急性上消化道出血患者可有效减少不良事件,提高其生活质量及满意度。     

肝硬化急性食管静脉曲张破裂出血的危险因素分析

目的探讨急性肝硬化食管静脉曲张破裂出血（EVB）的独立危险因素。方法回顾性分析87例肝硬化食管静脉曲张患者的临床和实验室资料,分为急性出血组及无急性出血组,利用单因素分析及多因素非条件Logistic回归分析筛选出影响急性肝硬化EVB的独立危险因素。结果单因素分析和多因素非条件Logistic回归分析结果显示,两组间上消化道出血史、白蛋白、凝血酶原时间、Child-Pugh评分、空腹血糖、红色征、食管静脉曲张程度差异均有统计学意义（P〈0.05）。结论上消化道出血史、凝血酶原时间延长、白蛋白下降、Child-Pugh评分和空腹血糖升高、红色征、食管静脉曲张程度加重为肝硬化急性EVB的独立危险因素,其中上消化道出血史为重要独立危险因素。     

完整Rockall和临床Rockall危险评分对老年急性非静脉曲张上消化道出血评估价值

目的 探讨完整和临床Rockall评分对老年急性非静脉曲张上消化道出血患者输血、再出血、干预和死亡的预测价值.方法 采用完整和临床Rockau评分系统对老年急性非静脉曲张上消化道出血患者进行危险程度分级,并与同期非老年组比较,应用ROC曲线评估两个评分系统的预测价值.结果 随着评分增加,老年临床高危患者所占比例逐渐增加,两者呈正相关（P＜0.05）.完整Rockall评分对老年患者输血、再出血、干预和死亡均有较好的预测价值,受试者工作特征曲线下面积AUC值分别为0.67、0.84、0.70和0.96（P ＜0.01）;临床Rockall评分对老年患者输血、再出血和死亡有较好的预测价值,AUC值分别为0.66、0.79和0.91（P ＜0.01）,对干预无预测价值（P＞0.05）.结论 老年急性非静脉曲张上消化道出血患者可用较为简单的临床Rockall评分预测输血、再出血和死亡风险.     

应用健康评价系统对205例肝硬化患者 病死率的预测

目的了解急性生理、年龄及慢性健康评价系统（acutephysiology,ageandchronichealthevaluation，APACHEⅢ）评分对肝硬化患者死亡危险预测的准确性。方法分别记录205例患者入院第一天的APACHEⅢ评分及Child-Pugh评分，应用判别分析比较两者预测的准确性。结果50例死亡。上消化道出血、肝性脑病、肝肾综合征、原发性肝癌和自发性腹膜炎等并发症的发生率分别为15.6%、10.6%、8.8%、8.8%和4.8%；主要死因为上消化道出血、肝肾综合征、肝功能衰竭、自发性腹膜炎。分别占40%、34%、20%、6%。生存组的APACHEⅢ评分及Child评分分别为19.3±8.6和7.4±1.8，显著低于死亡组（47.9±20.1，10.6±2.4），APACHE评分系统对住院患者死亡的预测准确率为82.3%，显著高于Child评分系统(72.7%)，其敏感性为67%，特异性为91%。综合凝血酶原时间延长时间及腹水指标，其预测准确率可提高至88.2%。结论对于肝硬化患者预后的评价，APACHEⅢ评分是一个较Child评分准确率高的预测系统，值得临床推广应用。     

肝硬化上消化道出血并发急性脑梗死10例临床分析

肝硬化上消化道出血死亡率较高,病情凶险。肝硬化上消化道出血并发急性脑梗死的病例较少见。2004年2月～2007年10月我院收治10例肝硬化上消化道出血并发急性脑梗死患者,现将其临床特点作回顾性分析,探讨肝硬化上消化道出血与急性脑梗死的关系,报道如下：     

血小板-白蛋白-胆红素指数（PALBI）联合AIMS65评分对肝硬化并发急性上消化道出血患者短期预后的预测价值

目的 探讨血小板-白蛋白-胆红素指数(PALBI)联合AIMS65评分对肝硬化并发急性上消化道出血(AUGIB)患者入院后6周内再出血及死亡的预测价值。方法 选取2021年2月—2022年10月在锦州医科大学附属第一医院住院治疗的肝硬化并发AUGIB患者238例,所有纳入患者均随访6周,根据预后情况分为死亡组(n=65)和生存组(n=173)、未再出血组(n=149)和再出血组(n=89)。收集患者的一般资料及实验室指标(血常规,肝、肾功能及凝血指标等),计算入院时的PALBI评分、AIMS65评分、Child-Turcotte-Pugh(CTP)评分、终末期肝病模型(MELD)评分。计量资料两组间比较采用成组t检验或Mann-Whitney U检验;计数资料两组间比较采用χ²检验。采用多因素Logistic回归模型分析肝硬化并发AUGIB患者入院治疗后6周内死亡或再出血的危险因素。通过受试者工作特征曲线(ROC曲线)及曲线下面积(AUC)评估各评分系统的预测效能;AUC的比较采用DeLong检验。结果 死亡组和生存组患者比较,呕血、既往有静脉曲张病史、Alb、T...     

改良NUTRIC评分和预后营养指数在老年肝硬化合并上消化道出血患者预后评估中的作用

目的 探究改良危重症营养风险评分(mNUTRIC)和预后营养指数(PNI)对老年肝硬化合并上消化道出血患者预后评估的作用.方法 108例老年肝硬化合并上消化道出血患者根据入院28 d时是否死亡分为存活组(n=66)和死亡组(n=42).收集患者的临床和实验室检查资料并计算患者的mNUTRIC评分和PNI评分.比较死亡组...     

乙肝病毒相关肝硬化并发急性上消化道出血的危险因素分析

[目的]研究乙肝病毒(HBV)相关肝硬化合并急性上消化道出血的危险因素,以期为临床诊治提供参考。[方法]将258例HBV相关肝硬化患者,按照是否合并急性上消化道出血分为研究组(142例,出血者)、对照组(116例,未出血者)。应用单因素分析HBV相关肝硬化合并急性上消化道出血的相关因素,再利用多因素Logistic分析对上述有差异的统计学资料进行进一步回归分析,最终探讨影响HBV相关肝硬化合并急性上消化道出血的危险因素。[结果]单因素分析显示,肝功能分级、凝血酶原时间、胃左静脉内径及血红蛋白为HBV相关肝硬化合并急性上消化道出血的危险因素,差异有统计学意义(P<0.05);多因素分析表明,肝功能分级、凝血酶原时间及胃左静脉内径为影响HBV相关肝硬化并急性上消化道出血的独立危险因素。[结论]HBV相关肝硬化合并急性上消化道出血的危险因素中肝功能分级、凝血酶原时间及胃左静脉内径为其独立危险因素。     

Predicting 6-week mortality after acute variceal bleeding: role of classification and regression tree analysis

Background. Available prognostic scores for mortality after acute variceal bleeding are mainly based on logistic regression analysis but may have some limitations that can restrict their clinical value.Aims. To assess the efficacy of a novel prognostic approach based on Classification and Regression Tree-CART-analysis to common easy-to-use models (MELD and Child-Pugh) for predicting 6-week mortality in patients with variceal bleeding.Methods. Sixty consecutive cirrhotic patients with acute variceal bleeding. CART analysis, MELD and Child-Pugh scores were performed to assess 6-week mortality. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive performance of the models.Results. Six-week rebleeding and mortality were 30% and 22%, respectively. Child-Pugh and MELD scores were clinically relevant for predicting 6 weeks mortality. CART analysis provided a simple algorithm based on just three bedside-available variables (albumin, bilirubin and in-hospital rebleeding), allowing accurate discrimination of two distinct prognostic subgroups with 3% and 80% mortality rates. All MELD, Child-Pugh and CART models showed excellent and comparable predictive accuracy, with areas under the ROC curves (AUROC) of 0.88, 0.84 and 0.91,respectively.Conclusions. A simple CART algorithm combining albumin, bilirubin and in-hospital rebleeding allows an accurate predictive assessment of 6-week mortality after acute variceal bleeding.     

Prognostic value of risk scoring systems for cirrhotic patients with variceal bleeding

BACKGROUND Acute variceal bleeding is one of the deadliest complications of cirrhosis,with a high risk of in-hospital rebleeding and mortality.Some risk scoring systems to predict clinical outcomes in patients with upper gastrointestinal bleeding have been developed.However,for cirrhotic patients with variceal bleeding,data regarding the predictive value of these prognostic scores in predicting in-hospital outcomes are limited and controversial.AIM To validate and compare the overall performance of selected prognostic scoring systems for predicting in-hospital outcomes in cirrhotic patients with variceal bleeding.METHODS From March 2017 to June 2019,cirrhotic patients with acute variceal bleeding were retrospectively enrolled at the Second Affiliated Hospital of Xi'an Jiaotong University.The clinical Rockall score(CRS),AIMS65 score(AIMS65),GlasgowBlatchford score(GBS),modified GBS(m GBS),Canada-United KingdomAustralia score(CANUKA),Child-Turcotte-Pugh score(CTP),model for endstage liver disease(MELD) and MELD-Na were calculated.The overall performance of these prognostic scoring systems was evaluated.RESULTS A total of 330 cirrhotic patients with variceal bleeding were enrolled;the rates of in-hospital rebleeding and mortality were 20.3% and 10.6%,respectively.For inhospital rebleeding,the discriminative ability of the CTP and CRS were clinically acceptable,with area under the receiver operating characteristic curves(AUROCs) of 0.717(0.648-0.787) and 0.716(0.638-0.793),respectively.The other tested scoring systems had poor discriminative ability(AUROCs 0.7).For inhospital mortality,the CRS,CTP,AIMS65,MELD-Na and MELD showed excellent discriminative ability(AUROCs 0.8).The AUROCs of the m GBS,CANUKA and GBS were relatively small,but clinically acceptable(AUROCs 0.7).Furthermore,the calibration of all scoring systems was good for either inhospital rebleeding or death.CONCLUSION For cirrhotic patients with variceal bleeding,in-hospital rebleeding and mortality rates remain high.The CTP and CRS can be used clinically to predict in-hospital rebleeding.The performances of the CRS,CTP,AIMS65,MELD-Na and MELD are excellent at predicting in-hospital mortality.     

Liver fibrosis index-based nomograms for identifying esophageal varices in patients with chronic hepatitis B related cirrhosis

BACKGROUNDEsophageal varices (EV) are the most fatal complication of chronic hepatitis B (CHB) related cirrhosis. The prognosis is poor, especially after the first upper gastrointestinal hemorrhage.AIMTo construct nomograms to predict the risk and severity of EV in patients with CHB related cirrhosis.METHODSBetween 2016 and 2018, the patients with CHB related cirrhosis were recruited and divided into a training or validation cohort at The First Affiliated Hospital of Wenzhou Medical University. Clinical and ultrasonic parameters that were closely related to EV risk and severity were screened out by univariate and multivariate logistic regression analyses, and integrated into two nomograms, respectively. Both nomograms were internally and externally validated by calibration, concordance index (C-index), receiver operating characteristic curve, and decision curve analyses (DCA).RESULTSA total of 307 patients with CHB related cirrhosis were recruited. The independent risk factors for EV included Child-Pugh class [odds ratio (OR) = 7.705, 95% confidence interval (CI) = 2.169-27.370, P = 0.002], platelet count (OR = 0.992, 95%CI = 0.984-1.000, P = 0.044), splenic portal index (SPI) (OR = 3.895, 95%CI = 1.630-9.308, P = 0.002), and liver fibrosis index (LFI) (OR = 3.603, 95%CI = 1.336-9.719, P = 0.011); those of EV severity included Child-Pugh class (OR = 5.436, 95%CI = 2.112-13.990, P < 0.001), mean portal vein velocity (OR = 1.479, 95%CI = 1.043-2.098, P = 0.028), portal vein diameter (OR = 1.397, 95%CI = 1.021-1.912, P = 0.037), SPI (OR = 1.463, 95%CI = 1.030-2.079, P = 0.034), and LFI (OR = 3.089, 95%CI = 1.442-6.617, P = 0.004). Two nomograms (predicting EV risk and severity, respectively) were well-calibrated and had a favorable discriminative ability, with C-indexes of 0.916 and 0.846 in the training cohort, respectively, higher than those of other predictive indexes, like LFI (C-indexes = 0.781 and 0.738), SPI (C-indexes = 0.805 and 0.714), ratio of platelet count to spleen diameter (PSR) (C-indexes = 0.822 and 0.726), King’s score (C-indexes = 0.694 and 0.609), and Lok index (C-indexes = 0.788 and 0.700). The areas under the curves (AUCs) of the two nomograms were 0.916 and 0.846 in the training cohort, respectively, higher than those of LFI (AUCs = 0.781 and 0.738), SPI (AUCs = 0.805 and 0.714), PSR (AUCs = 0.822 and 0.726), King’s score (AUCs = 0.694 and 0.609), and Lok index (AUCs = 0.788 and 0.700). Better net benefits were shown in the DCA. The results were validated in the validation cohort.CONCLUSIONNomograms incorporating clinical and ultrasonic variables are efficient in noninvasively predicting the risk and severity of EV.     

Model for end stage of liver disease (MELD) is better than the Child-Pugh score for predicting in-hospital mortality related to esophageal variceal bleeding

Aim: The Child Pugh and MELD are good methods for predicting mortality in patients with chronic liver disease. We investigated their performance as risk factors for failure to control bleeding, in-hospital overall mortality and death related to esophageal variceal bleeding episodes. Methods: From a previous collected database, 212 cirrhotic patients with variceal bleeding admitted to our hospital were studied. The predictive capability of Child Pugh and MELD scores were compared using c statistics. Results: The Child-Pugh and MELD scores showed marginal capability for predicting failure to control bleeding (the area under receiver operating characteristics curve (AUROC) values were < 0.70 for both). The AUROC values for predicting inhospital overall mortality of Child-Pugh and MELD score were similar: 0.809 (CI 95%, 0.710 - 0.907) and 0.88 (CI 95% 0.77-0.99,) respectively. There was no significant difference between them (p > 0.05). The AU-ROC value of MELD for predicting mortality related to variceal bleeding was higher than the Child-Pugh score: 0.905 (CI 95% 0.801-1.00) vs 0.794 (CI 95% 0.676 - 0.913) respectively (p < 0.05). Conclusions: MELD and Child-Pugh were not efficacious scores for predicting failure to control bleeding. The Child-Pugh and MELD scores had similar capability for predicting in-hospital overall mortality. Nevertheless, MELD was significantly better than Child-Pugh score for predicting in-hospital mortality related to variceal bleeding.     

三种评分系统在肝硬化食管胃底静脉曲张破裂出血患者风险评估中的应用

目的探讨MELD(model for end-stage liver disease)、GBS(glasgow-blatchford score)、AIMS65评分系统在肝硬化食管胃底静脉曲张破裂出血(esophageal and gastric variceal bleeding,EGVB)患者风险评估中的临床应用价值。方法对天津医科大学总医院消化内科2015年1月1日至2018年3月1日入院的182例肝硬化EGVB患者进行回顾分析,依据MELD、GBS、AIMS65评分系统标准针对每例患者进行评分,评估各评分系统正确将肝硬化EGVB归为"高风险患者"的能力,并绘制受试者工作特征曲线(receiver-operating characteristic curve,ROC),采用曲线下面积(area under curve,AUC)评估各评分系统针对不同临床结局(输血、再出血、住院死亡)的预测能力,AUC>0.7认为有较高准确性。结果临床结局包括输血113例(62.1%)、再出血31例(17.0%)、死亡11例(6.0%)。MELD评分得分为7~25分,其中得分<9分4例(2.2%);GBS评分得分为3~16分;AIMS65评分得分为0~3分,其中得分0~1分139例(76.4%,0分68例、1分71例)。MELD、GBS、AIMS65评分系统预测输血的AUC分别为0.514(95%CI:0.439~0.589)、0.681(95%CI:0.608~0.748)、0.669(95%CI:0.596~0.737);预测再出血的AUC分别为0.525(95%CI:0.449~0.599)、0.528(95%CI:0.453~0.602)、0.580(95%CI:0.505~0.652);预测住院死亡的AUC分别为0.642(95%CI:0.567~0.711)、0.581(95%CI:0.505~0.653)、0.786(95%CI:0.719~0.843),AIMS65优于MELD(P=0.0836)和GBS(P=0.0470)。结论GBS能正确将肝硬化EGVB患者归类为"高风险人群",优于AIMS65和MELD评分系统。对于肝硬化EGVB患者,3种评分系统对输血和再出血的预测价值均不高,AIMS65对住院死亡有较高的预测价值。     

Platelet-albumin-bilirubin score-a predictor of outcome of acute variceal bleeding in patients with cirrhosis

BACKGROUND The albumin-bilirubin(ALBI) score was validated as a prognostic indicator in patients with liver disease and hepatocellular carcinoma. Incorporating platelet count in the platelet-albumin-bilirubin(PALBI) score improved validity in predicting outcome of patients undergoing resection and ablation.AIM To evaluate the PALBI score in predicting outcome of acute variceal bleeding in patients with cirrhosis.METHODS The data of 1517 patients with cirrhosis presenting with variceal bleeding were analyzed. Child Turcotte Pugh(CTP) class, Model of End-stage Liver Disease(MELD), ALBI and PALBI scores were calculated on admission, and were correlated to the outcome of variceal bleeding. Areas under the receivingoperator characteristic curve(AUROC) were calculated for survival and rebleeding.RESULTS Mean age was 52.6 years; 1176 were male(77.5%), 69 CTP-A(4.5%), 434 CTP-B(29.2%), 1014 CTP-C(66.8%); 306 PALBI-1(20.2%), 285 PALBI-2(18.8%), and 926 PALBI-3(61.1%). Three hundred and thirty-two patients died during hospitalization(21.9%). Bleeding-related mortality occurred in 11% of CTP-B,28% of CTP-C, in 21.8% of PALBI-2 and 34.4% of PALBI-3 patients. The AUROC for predicting survival of acute variceal bleeding was 0.668, 0.689, 0.803 and 0.871 for CTP, MELD, ALBI and PALBI scores, respectively. For predicting rebleeding the AUROC was 0.681, 0.74, 0.766 and 0.794 for CTP, MELD, ALBI and PALBI scores, respectively.CONCLUSION PALBI score on admission is a good prognostic indicator for patients with acute variceal bleeding and predicts early mortality and rebleeding.     

血清-腹水白蛋白梯度对失代偿期乙型肝炎肝硬化患者发生EVB风险的预测价值*

目的 研究血清-腹水白蛋白梯度(SAAG)预测失代偿期乙型肝炎肝硬化患者并发食管静脉曲张破裂出血(EVB)的临床价值。方法 2017年4月～2019年10月我院收治的失代偿期乙型肝炎肝硬化患者84例,根据是否发生EVB分组,计算SAAG和校正的SAAG值。采用Logistic多因素分析患者并发EVB的独立影响因素,采用受试者工作特征曲线(ROC)并计算曲线下面积(AUC)分析各指标预测EVB风险的临床价值。结果 在随访的6个月内,本组发生EVB 18例,未发生66例;EVB患者年龄≥65岁的比例为72.2%,显著大于肝硬化患者(43.9%,P<0.05);EVB患者血清白蛋白水平为(35.8±2.7)g/L,显著低于肝硬化患者【(37.7±3.3)g/L,P<0.05】,血小板计数为(52.3±10.7)×10⁹/L,显著低于肝硬化患者【(59.4±12.5)×10⁹/L,P<0.05】,部分凝血酶原时间(APTT)为(45.8±5.9)s,显著长于肝硬化患者【(41.1±7.4)s,P<0.05】,SAAG为(18.7±5.1),显著大于肝硬化患者【(16.1±4.2),P<0.05】,矫正的SAAG为(9.2±2.4),显著大于肝硬化患者【(7.6±1.8),P<0.05】;脾脏厚度为(5.2±1.3)cm,显著大于肝硬化患者【(4.5±0.8)cm,P<0.05】,门静脉血流速度为(15.2±2.9)cm/s,显著慢于肝硬化患者【(17.0±3.3)cm/s,P<0.05】;Logistic多因素分析显示血清白蛋白(OR=0.435,95%CI=0.287～0.659)、腹水白蛋白(OR=1.845,95%CI=1.063～3.202)、APTT(OR=1.469,95%CI=1.272～1.697)、MELD评分(OR=3.285,95%CI=1.697～6.359)和矫正的SAAG(OR=2.917,95%CI=1.337～6.364)是影响失代偿期乙型肝炎肝硬化患者并发EVB的独立因素(P<0.05);采用校正的SAAG和MELD预测EVB的AUC分别为0.827和0.791,其敏感度分别为0.889和0.787,特异度分别为0.636和0.612。结论 采用矫正的SAAG有助于预测失代偿期乙型肝炎肝硬化患者并发EVB的风险,因其简单,值得临床应用验证。     

MELD vs Child-Pugh and creatinine-modified Child-Pugh score for predicting survival in patients with decompensated cirrhosis

AIM：Model of End-stage Liver Disease (MELD) score has recently gained wide acceptance over the old Child-Pugh score in predicting survival in patients with decompensated cirrhosis, although it is more sophisticated. We compared the predictive values of MELD, Child-Pugh and creatininemodified Child-Pugh scores in decompensated cirrhosis.METHODS: A cohort of 102 patients with decompensated cirrhosis followed-up for a median of 6 mo was studied.Two types of modified Child-Pugh scores estimated by adding 0-4 points to the original score using creatinine levels as a sixth categorical variable were evaluated.RESULTS: The areas under the receiver operating characteristic curves did not differ significantly among the four scores, but none had excellent diagnostic accuracy (areas:0.71-0.79). Child-Pugh score appeared to be the worst, while the accuracy of MELD was almost identical with that of modified Child-Pugh in predicting short-term and slightly better in predi~ng medium-term survival. In Cox regression analysis, all four scores were significantly associated with survival, while MELD and creatinine-modified Child-Pugh scores had better predictive values (c-statistics: 0.73 and 0.69-0.70) than Child-Pugh score (c-statistics: 0.65).Adjustment for gamma-glutamate transpeptidase levels increased the predictive values of all systems (c-statistics:0.77-0.81). Analysis of the expected and observed survival curves in patients subgroups according to their prognosis showed that all models fit the data reasonably well with MELD probably discriminating better the subgroups withworse prognosis.CONCLUSION: MELD compared to the old Child-Pugh and particularly to creatinine-modified Child-Pugh scores does not appear to offer a clear advantage in predicting survival in patients with decompensated cirrhosis in daily clinical practice.     

MELD vs Child-Pugh and creatinine-modified Child-Pugh score for Dredicting survival in patients with decompensated cirrhosis

AIM: Model of End-stage Liver Disease (MELD) score has recently gained wide acceptance over the old Child-Pugh score in predicting survival in patients with decompensated cirrhosis, although it is more sophisticated. We compared the predictive values of MELD, Child-Pugh and creatinine-modified Child-Pugh scores in decompensated cirrhosis. METHODS: A cohort of 102 patients with decompensated cirrhosis followed-up for a median of 6 mo was studied. Two types of modified Child-Pugh scores estimated by adding 0-4 points to the original score using creatinine levels as a sixth categorical variable were evaluated. RESULTS: The areas under the receiver operating characteristic curves did not differ significantly among the four scores, but none had excellent diagnostic accuracy (areas: 0.71-0.79). Child-Pugh score appeared to be the worst, while the accuracy of MELD was almost identical with that of modified Child-Pugh in predicting short-term and slightly better in predicting medium-term survival. In Cox regression analysis, all four scores were significantly associated with survival, while MELD and creatinine-modified Child-Pugh scores had better predictive values (c-statistics: 0.73 and 0.69-0.70) than Child-Pugh score (c-statistics: 0.65). Adjustment for gamma-glutamate transpeptidase levels increased the predictive values of all systems (c-statistics: 0.77-0.81). Analysis of the expected and observed survival curves in patients subgroups according to their prognosis showed that all models fit the data reasonably well with MELD probably discriminating better the subgroups with worse prognosis. CONCLUSION: MELD compared to the old Child-Pugh and particularly to creatinine-modified Child-Pugh scores does not appear to offer a clear advantage in predicting survival in patients with decompensated cirrhosis in daily clinical practice.     

Chronic liver failure-consortium acute-on-chronic liver failure and acute decompensation scores predict mortality in Brazilian cirrhotic patients

AIM To validate prognostic scores for acute decompensation of cirrhosis and acute-on-chronic liver failure in Brazilian patients.METHODS This is a prospective cohort study designed to assess the prognostic performance of the chronic liver failure-consortium(CLIF-C) acute decompensation score(CLIF-C AD) and CLIF-C acute-on-chronic liver failure score(CLIF-C ACLF),regarding 28-d and 90-d mortality,as well as to compare them to other prognostic models,such as Model for End-Stage Liver Disease(MELD),MELD Sodium(MELD-Na),ChildPugh(CP) score,and the CLIF-C Organ Failure score(CLIF-C OF). All participants were adults with acute decompensation of cirrhosis admitted to the Emergency Department of a tertiary hospital in southern Brazil. Prognostic performances were evaluated by means of the receiver operating characteristic(ROC) curves,area under the curves(AUC) and 95%CI.RESULTS One hundred and thirteen cirrhotic patients were included. At admission,18 patients had acute-onchronic liver failure(ACLF) and 95 individuals had acute decompensation(AD) without ACLF,of which 24 eventually developed ACLF during the course of hospitalization(AD evolving to ACLF group). The AD group had significantly lower 28-d(9.0%) and 90-d(18.3%) mortality as compared to the AD evolving to ACLF group and to the ACLF group(both P 0.001). On the other hand,28-d and 90-d mortalities were not significantly different between AD evolving to ACLF group and ACLF group(P = 0.542 and P = 0.708,respectively). Among patients with ACLF,at 28 d from the diagnosis,CLIF-C ACLF was the only score able to predict mortality significantly better than the reference line,with an AUC(95%CI) of 0.71(95%CI: 0.54-0.88,P = 0.021). Among patients with AD,all prognostic scores performed significantly better than the reference line regarding 28-d mortality,presenting with similar AUCs: CLIF-C AD score 0.75(95%CI: 0.63-0.88),CP score 0.72(95%CI: 0.59-0.85),MELD score 0.75(95%CI: 0.61-0.90),MELD-Na score 0.76(95%CI: 0.61-0.90),and CLIF-C OF score 0.74(95%CI: 0.60-0.88). The same occurred concerning AUCs for 90-d mortality: CLIF-C AD score 0.70(95%CI: 0.57-0.82),CP score 0.73(95%CI: 0.62-0.84),MELD score 0.71(95%CI: 0.59-0.83),MELD-Na score 0.73(95%CI: 0.62-0.84),and CLIF-C OF score 0.65(95%CI: 0.52-0.78).CONCLUSION This study demonstrated that CLIF-C ACLF is the best available score for the prediction of 28-d mortality among patients with ACLF. CLIF-C AD score is also useful for the prediction of mortality among cirrhotic patients with AD not fulfilling diagnostic criteria for ACLF,but it was not superior to other well-established prognostic scores.