肝硬化合并急性上消化道出血的预后评分系统对比

The Comparison of the Current Prognostic Models of Patients with Cirrhosis and Acute Variceal Bleeding

目的对比现行的肝硬化合并急性上消化道出血的预后评分系统。方法回顾性分析2019年1~12月西安交通大学第一附属医院因肝硬化上消化道出血住院的患者资料,对比Child-Pugh评分、CAGIB评分、MELD评分及NLR评分系统的曲线下面积(area under curve,AUC)。结果共有328例肝硬化伴急性消化道出血的连续病例纳入分析。57例(17.4%)患者合并肝癌。在整体包含了328例患者的队列中,Child-Pugh评分、CAGIB评分、MELD评分及NLR评分的AUC值分别为0.836(95%CI:0.791~0.875)、0.827(95%CI:0.781~0.867)、0.764(95%CI:0.714~0.809)、0.687(95%CI:0.633~0.737)。其中,Child-Pugh与NLR之间差异有统计学意义(P=0.037)。在剔除肝癌的271例患者队列中,Child-Pugh评分、CAGIB评分、MELD评分及NLR评分的AUC值分别为0.840(95%CI:0.790~0.882)、0.728(95%CI:0.671~0.781)、0.742(95%CI:0.685~0.794)、0.726(95%CI:0.668~0.779)。结论相比于NLR评分系统,Child-Pugh评分、CAGIB评分、MELD评分对于肝硬化急性上消化道出血的院内死亡的预后评估具有更好的价值,Child-Pugh评分的预后价值最高。

Objective To validate the current prognostic models in patients with cirrhosis and acute variceal bleeding.Methods Patients with cirrhosis and acute variceal bleeding were retrospectively included from Jan 2019 to Dec 2019.Area under curves(AUCs)of cirrhosis acute gastrointestinal bleeding(CAGIB)score was compared with that of Child-Pugh,model for end-stage liver disease(MELD),and neutrophil-lymphocyte ratio(NLR)scores.Results In total,328 patients with liver cirrhosis and acute variceal bleeding were consecutively evaluated.57(17.4%)patients had hepatocellular carcinoma.In the whole cohort with HCC patients,the AUCs of Child-Pugh,CAGIB,MELD,NLR scores were 0.836(95%CI 0.791-0.875),0.827(95%CI 0.781-0.867),0.764(95%CI 0.714-0.809)and 0.687(95%CI 0.633-0.737),respectively.The differences were statistically significant between Child-Pugh and NLR scores(P=0.037).In the cohort without HCC,the AUCs of Child-Pugh,CAGIB,MELD,NLR scores were 0.840(95%CI 0.790-0.882),0.728(95%CI 0.671-0.781),0.742(95%CI 0.685-0.794)and 0.726(95%CI 0.668-0.779),respectively.Conclusion Our study suggested that Child-Pugh,CAGIB and MELD scores showed better predictive performance for prognosis of patients with cirrhosis and acute variceal bleeding than NLR scores.