三种评分方法预测肝硬化并食管静脉曲张破裂再出血风险的价值比较

Objective To compare the predictive value of the model for end-stage liver disease (MELD), MELD-Na and Child-Pugh (CP) for rebleeding in decompensated liver cirrhosis patients with esophageal varices within 3-month and 1-year. Methods A cohort of 365 decompensated liver cirrhotic patients with esophageal varices, who were admitted to hospital between Jan.2003 and Oct.2008, were retroseptively studied and followed up at least for one year. Patients were divided into hyponatremia group and normal group. MELD-Na, MELD and Child-Pugh scores were calculated for each patients on the first day of admission.Receiver operating characteristics curves (ROC) and the area under ROC (AUC) were used to determine the ability of three models for predicting rebleeding in 3-month and 1-year. Z-test was used to compare predictive ability of three models. Results At 3-month and 1 year of enrollment, AUC of MELD-Na was 0.825 and 0.842, respectively, whereas AUC of MELD was 0.779 and 0.802, respectively. MELD-Na and MELD were superior to Child-Pugh in rebleeding prediction (0.678 and 0.634, P＜0.05). But there was no significantly difference between MELD-Na and MELD in rebleeding prediction for 3-month and 1-year (P＞ 0.05). Conclusions MELD-Na and MELD are superior to Child-Pugh score in exactly predicting the rebleeding risk in decompensated liver cirrhosis patients with esophageal varices. MELD-Na compensates a deficiency of MELD.

A comparative study of three prognostic systems for rebleeding in decompensated liver cirrhotic patients with esophageal varices