肝脏特异性多器官功能衰竭评分预测酒精性肝硬化患者预后的价值

Prognostic value of liver-specific multiple organ failure score in patients with alcoholic liver cirrhosis

目的探讨肝脏特异性多器官功能衰竭评分预测酒精性肝硬化患者预后的价值。方法自2012年1月—2017年6月,回顾性收集宁波市第二医院收治的酒精性肝硬化伴肝功能衰竭患者126例,对患者随访1年,根据患者1年内是否死亡,将患者分为死亡组(34例)和存活组(92例)。分析2组患者慢性肝功能衰竭协会-器官功能衰竭评分(CLIF-COFs)、APACHEⅡ评分、SOFA评分、终末期肝病模型-钠评分和终末期肝病模型评分差异,同时采用ROC曲线分析上述指标在判断酒精性肝硬化患者1年内死亡中的价值。结果与存活组比较,死亡组患者CLIF-COFs显著增高(11.35±3.15vs.6.46±2.61,P<0.001);APACHEⅡ评分显著增高(15.85±6.37vs.12.01±5.65,P=0.001);SOFA评分显著增高(6.62±1.74vs.4.22±1.63,P<0.001);终末期肝病模型-钠评分显著增高(25.41±4.29vs.21.25±4.07,P<0.001);终末期肝病模型评分显著增高(22.94±5.07vs.17.88±6.20,P<0.001);Maddery评分显著增高(63.37±18.47vs.49.82±19.67,P=0.001)。CLIF-COFs、APACHEⅡ评分、SOFA评分、终末期肝病模型-钠评分、终末期肝病模型评分和Maddery评分在诊断酒精性肝硬化患者1年内死亡的曲线下面积分别为0.875、0.672、0.831、0.751、0.728、0.852,其中CLIF-COFs最高[0.875(0.811~0.939),P<0.001]。结论肝脏特异性多器官功能衰竭评分预测酒精性肝硬化患者预后具有较好价值,可进一步推广应用。

Objective To evaluate the prognostic value of liver-specific multiple organ failure ( MOF) score in patients with alcoholic liver cirrhosis. Methods From January,2012 to June,2017,126 patients with alcoholic liver cirrhosis and liver failure admitted to the Second hospital of Ningbo were retrospectively collected. The patients were followed up for one year. According to whether the patients died within one year or not,the patients were divided into a death group ( n = 34) and a survival group ( n = 92) . The differences of CLIF-COFs,APACHE Ⅱ,SOFA,end-stage liver disease model-sodium and end-stage liver disease model scores between the two groups were analyzed. The ROC curve was used to analyze the value of these indexes in the diagnosis of death in alcoholic liver cirrhosis within one year. Results When compared with the survival group,the CLIF-COFs in the death group were significantly higher ( 11. 35 ± 3. 15 vs. 6. 46 ± 2. 61,P < 0. 001) ; the APACHE Ⅱ score was significantly higher ( 15. 85 ± 6. 37 vs. 12. 01 ± 5. 65,P = 0. 001) ; the SOFA score was significantly higher ( 6. 62 ± 1. 74 vs. 4. 22 ± 1. 63,P < 0. 001) ; the sodium score in the end-stage liver disease model was significantly higher ( 25. 41 ± 4. 29 vs. 21. 25 ± 4. 07,P < 0. 001) ; the score of end-stage liver disease model was significantly higher ( 22. 94 ± 5. 07 vs. 17. 88 ± 6. 20,P < 0. 001) ; Maddery score increased significantly ( 63. 37 ± 18. 47 vs. 49. 82 ± 19. 67,P = 0. 001) . CLIF-COFs,APACHE Ⅱ score,SOFA score,end-stage liver disease model-sodium score,end-stage liver disease model score and Maddery score were 0. 875,0. 672,0. 831,0. 751 and 0. 728 under the diagnostic curve of death in alcoholic cirrhosis patients within one year,respectively,of which CLIFCOFs was the highest[0. 875 ( 0. 811 - 0. 939) ,P < 0. 001]. Conclusion Liver-specific multiple organ failure score is valuable in predicting the prognosis of alcoholic liver cirrhosis,and can be further applied.