肝衰竭评分模型与ICU通用评分法对76例病毒性肝炎乙型慢加急肝衰竭患者院内死亡判别力的比较

Hospital mortality prediction of four severity scoring models on hepatitis B and acuteon-chronic liver failure: an analysis of 76 cases

目的:比较各类肝衰竭评分模型及ICU专用评分法对病毒性肝炎乙型慢加急肝衰竭患者院内死亡判别力.方法:将76例病毒性肝炎乙型慢加急肝衰竭患者分为存活组(n=42)及死亡组(n=34),分别采用肝衰竭评分模型及ICU专用评分,即MELD,SMSVH与APACHEⅡ,APACHEⅢ,对所选患者予回顾性病情评估,并通过受试者工作特征(ROC)曲线进行分析.结果:死亡组评分显著高于存活组(MELD:38.19±8.09 vs 24.12±7.16;SMSVH:5.29±1.36 vs 4.19±1.09;APACHEⅡ:15.47±4.06 vs 10.79±2.56:APACHEⅢ:73.50±17.79 vs 60.02±10.06;均P<0.01).各评分法ROC曲线下面积均大于0.7,从大到小依次为:MELD (0.906)、APACHEⅡ(0.848)、APACHEⅢ(0.770)、SMSVH(0.749).结论:MELD评分法对病毒性肝炎乙型慢加急肝衰竭患者院内死亡判别力最佳.

AIM： To compare the applicability between liver failure special severity scoring systems and intensive care unit （ICU） general severity scoring systems on predicting the hospital mortality of critical hepatitis B and acute-on-chronic liver failure patients. METHODS： The data of 76 patients with hepatitis B and acute-on-chronic liver failure were retrospectively analyzed. The patients were divided into dead group （n = 34） and survival group （n = 42）. Two liver failure special severity scoring models, MELD and SMSVH, and ICU general severity scoring models, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） and APACHEⅢ, were used in the analysis. The receiver operating characteristic （ROC） curves were drawn up to assess the ability of these models in hospital mortality discrimination. RESULTS： The scores in death group were significantly higher than those in survival group （MELD： 38.19 ± 8.09 vs 24.12 ± 7.16; SMSVH： 5.29 ± 1.36 vs 4.19 ± 1.09; APACHE Ⅱ： 15.47 ± 4.06 vs 10.79 ± 2.56; APACHEⅢ： 73.50 ± 17.79 vs 60.02 ± 10.06; all P 〈 0.01）. The areas under ROC curves for these 4 models were 0.906 （MELD）, 0.848 （APACHE Ⅱ）, 0.770 （APACHEⅢ） and 0.749 （SMSVH）. CONCLUSION： MELD exhibits the best ability to predict hospital mortality.