应用多器官功能障碍综合征评分评估肝功能衰竭预后的临床价值

目的观察应用多器官功能障碍综合征（MODS）评分评估肝功能衰竭预后的临床价值。方法入选肝功能衰竭患者189例，观察患者入院24h内的生命体征、血小板、凝血酶原时间、国际标准化比值、吸氧浓度、动脉血氧分压、总胆红素、白蛋白、血肌酐、压力校正心率、神经系统评分、腹水程度、肝性脑病分期等。分别按MODS、Child-Putgh—Turcotte（CTP）和终末期肝病模型（MELD）评分的标准计算每例患者的分值，根据结局分为生存组（64例）和死亡组（125例），比较两组的MODS评分差别。用受试者特征曲线评价比较MODS、CTP和MELD评分预测肝功能衰竭预后的能力，用K-M生存曲线比较不同MODS评分分值组的生存时间。结果死亡组的凝血酶原时间、国际标准化比值、动脉血氧分压、血肌酐、神经系统评分和肝性脑病分期均高于生存组，两组总胆红素、白蛋白、血小板、吸氧浓度、压力校正心率和腹水程度差异无统计学意义；死亡组的MODS评分（9±2）高于生存组（7±1），t=9．076，P〈0．01；受试者特征曲线分析显示，MODS评分的曲线下面积（0．814）接近MELD评分（0．827），高于CTP评分（0．714）；不同MODS评分分值组的生存时间差异有统计学意义（χ^2=72．451，P〈0．01）。结论MODS评分用于评估肝功能衰竭预后的临床价值和MELD评分相当，优于CTP评分。MODS评分可以用于评估肝功能衰竭患者的近期预后。

Clinical value of multiple organ dysfunction syndrome score in evaluating prognosis for patients with liver failure

Objective To study clinical value of multiple organ dysfunction syndrome (MODS) score to evaluate prognosis for patients with liver failure. Methods A total of 189 patients with liver failure were recruited into the study, 125 deaths and 64 survivals. Their vital sign, platelets count (PLT), prothrombin time (PT) and international normalized ratio of PT (INRPT), fraction of inhaled oxygen (FiO2), arterial oxygen partial pressure (PaO2), serum levels of total bilirubin (TB), albumin (ALB), creatinine (Cr), pressure-adjusted heart rate (PAHR), glasgow coma score (GCS), degree of aacitic fluid (DAF) and stage of hepatic encephalopathy (SHE) were evaluated within 24 hours after admission. Each of the patients scored according to the criteria of MODS score, Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease (MELD) score. Difference in MODS score between death and survival groups was compared and accuracy of prognosis of MODS score, CTP score and MELD score were evaluated by the area under receiver operating characteristic (ROC) curve. Survival time of patients in the two groups classified by their MODS scores was compared with Kaplan-Meier (K-M) survival curve. Results There was significant difference in PT, INRPT, PaO2, Cr, GCS, SHE between death and survival groups, but there was no difference in TB, ALB, PLT, FiO2, PHAR and DAF between them. Mean score of MODS in death group (9±2) was significantly higher than that in survival group (7±1) (t=9.076, P<0.01). The area under ROC curve (AUC) of MODS score (0.814) was close to that of MELD score (0.827), but higher than that of CTP score (0.714). There was significant difference in survival time between the varied groups classified by MODS score (χ2=72.451, P<0.01). Conclusions Clinical value of MODS score is equivalent to that of MELD score in evaluating prognosis for patients with liver failure, even better than that of CTP score, which can be used to evaluate short-term prognosis for patients with liver failure.