The predictive values of four scoring systems in short-term prognosis of patients with hepatitis B-associated acute-on-chronic liver failure
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摘要:
目的比较MELD、MELD-Na、i MELD及MESO四种评分系统预测乙型肝炎相关慢加急性肝衰竭(ACLF)患者经过人工肝治疗短期预后的价值。方法选取2007年10月-2013年2月于天津市第二人民医院住院的乙型肝炎相关ACLF患者221例,分为存活组(139例)和死亡组(82例),测量并比较2组的TBil、血清肌酐(Cr)、国际标准化比值(INR)、血清钠(Na+)以及MELD、MELD-Na、i MELD、MESO评分值。计量资料两组间比较采用独立样本Mann-Whitney U检验或t检验,多组间比较采用KruskalWaillis H检验;计数资料组间比较采用χ2检验;受试者工作特征曲线下面积(AUC)比较采用正态Z检验。结果死亡组的年龄、TBil、INR、MELD、MELD-Na、i MELD及MESO评分均高于存活组,血清Na+水平低于存活组,差异均有统计学意义(P值均<0.001)。肝衰竭晚期各评分均明显高于中期和早期(P值均<0.001),肝衰竭中期各评分均高于早期(P值均<0.001)。MELD、MELD-Na、i MELD及MESO评分越高,病死...
Abstract:Objective To investigate the predictive values of four scoring systems,the Model for End-Stage Liver Disease( MELD),the MELD with incorporation of serum sodium( MELD-Na),the integrated MELD( i MELD),and the MELD to serum sodium ratio( MESO),in the short-term prognosis of patients with hepatitis B-associated acute-on-chronic liver failure( ACLF) after artificial liver support therapy. Methods A total of 221 patients with hepatitis B-associated ACLF who were hospitalized from October 2007 to February 2013 were enrolled as subjects and divided into survival group( n = 139) and death group( n = 82). The levels of total bilirubin( TBil),serum creatinine( Cr),international normalized ratio( INR),serum sodium( Na+),and the scores of MELD,MELD-Na,i MELD,and MESO were determined and compared between the two groups. Comparison of continuous data between two groups was made by the Mann-Whitney U test or t test; comparison between multiple groups was made by the Kruskal-Wallis H test; comparison of categorical data was made by χ2test; comparison of area under the receiver operating characteristic curve was made by normal Z test. Results The age,TBil level,INR,and the scores of MELD,MELD-Na,i MELD,and MESO were significantly higher in the death group than in the survival group,while the serum level of Na+was significantly lower in the death group than in the survival group( P < 0. 001). Patients with end-stage liver failure had significantly higher scores than those with early-stage or intermediate-stage liver failure( P < 0. 001),while patients with intermediate-stage liver failure had significantly higher scores than those with early-stage liver failure( P < 0. 001). The mortality rate increased with increasing scores of MELD,MELD-Na,i MELD,and MESO. The optimal cut-off scores of MELD,MELD-Na,i MELD,and MESO were 37. 989,41. 291,55. 406,and 2. 693,respectively. There were no significant differences between any two scoring systems( P > 0. 05). Conclusion All four scoring systems can well predict the short-term clinical prognosis in patients with hepatitis B-associated ACLF after artificial liver support therapy combined with comprehensive medical treatment. The i MELD scoring system is slightly superior to the other three scoring systems.However,the application of these scoring systems still needs to be closely associated with actual clinical situations.
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Key words:
- liver failure /
- hepatitis B /
- liver,artificial /
- prognosis /
- comp study
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