多种评分方法对失代偿期肝硬化患者短期预后的预测价值

The predictive values of different scoring system for short-term prognosis of patients with decompensated liver cirrhosis

目的比较CPT评分、MELD评分、MELD-Na评分和iMELD评分对失代偿期肝硬化患者短期预后的预测价值。方法采用病例对照法对249例失代偿期肝硬化患者临床资料进行回顾性分析。收集患者入院当日的临床资料,计算CPT评分、MELD评分、MELD-Na评分及iMELD评分。以1周、2周、1个月和3个月4个时间点患者的存活情况为依据,运用ROC曲线下面积(AUC)比较以上4种评分对肝硬化失代偿期患者短期预后的预测价值。结果 249例患者中有77例于3个月内死亡,存活组(172例,69.1%)与死亡组(77例,30.9%)比较,AUC预测1周、2周、1个月和3个月生存期的价值均为:iMELD评分>MELD-Na评分>MELD评分>CPT评分。iMELD评分的分辨力显著优于其他评分系统,差异具有统计学意义(P<0.05)。结论 CPT分级、MELD评分、MELD-Na评分和iMELD评分对肝硬化失代偿期患者短期预后均有一定的预测价值,但iMELD评分对肝硬化失代偿期患者短期预后预测价值更佳。

Objective To compare the prediction values of Child-Pugh-Turcotte classification, MELD score, MELD-Na score and iMELD score in the short-term prognosis of patients with decompensated liver cirrhosis. Method The methodology of case-control study was carried out in the study. Data of 249 patients with decompensated liver cirrhosis were analyzed, retrospectively. Based on the patients case history and subsequent-visit information, and according to death or no death in one week, two weeks, one month, three months after hospitalization, the short-term prognosis of patients with decompensated liver cirrhosis, by Child-Turcotte-Pugh classification, MELD score, MELD-Na score and iMELD score were calculated. The mortality of patients with different Child-Turcotte-Pugh classification, MELD score, MELD-Na score and iMELD score were compared. Prediction of mortality at the above time points were analyzed through the area under the receiver’s operating characteristics curve （AUC）. Results There were 77 patients died in three months among the 249 patients. The prediction value of survival time at one week, two weeks, one month and three months were analyzed by AUC, and the prediction value of survival time at every time points were iMELD scoreMELD-Na scoreMELD scoreCPT score. The prediction value of iMELD at every time nods were better than CPT, MELD and MELD-Na score, and the differences were significant （P0.05）. Conclusions CPT classification, MELD score, MELD-Na score and iMELD score could predict the short-term prognosis of patients with decomensated cirrhosis. The distinguishing ability of iMELD was better than that of the others. The short-term prospective value of iMELD score for patients with decomensated cirrhosis is much better method.