PALBI、MELD及INR值与肝硬化患者合并上消化道出血患者预后的关系及多因素研究

Relationship between PALBI,MELD,INR and the prognosis of patients with liver cirrhosis combined with upper gastrointestinal hemorrhage and a multivariate study

目的探讨血小板-白蛋白-胆红素评分(PALBI)、终末期肝病模型(MELD)评分、国际标准化比值(INR)对于预测肝硬化合并上消化道出血患者预后中的价值。方法回顾性选取2017年1月至2020年12月期间在东营市人民医院接受治疗的肝硬化合并上消化道出血患者211例进行研究,其中38例患者28 d内死亡(死亡组)、173例患者治疗好转后出院(生存组)。对比两组患者入院时的PALBI、MELD评分、INR,采用受试者工作特征曲线评价3项指标预测患者治疗结局的价值,采用Logistic模型分析影响患者预后结局的相关因素。结果死亡组患者的PALBI、MELD评分、INR值分别为(-1.44±0.43)分、(17.55±4.50)分、1.60±0.24,均高于生存组[(-1.96±0.58)分、(11.68±2.77)分、1.25±0.22],差异均有统计学意义(P<0.05)。ROC曲线结果显示PALBI、MELD评分、INR值预测患者死亡的AUC值分别为0.815、0.892、0.677。Logistic回归模型结果显示患者合并肺部感染、自发性腹膜炎、肝性脑病,血乳酸、PALBI、MELD评分、INR值增高是患者不良预后的独立危险因素(P<0.05)。结论入院时的PALBI、MELD评分对于预测患者不良预后结局具有较高的临床价值,PALBI、MELD评分、INR水平增高会增大患者不良预后结局的风险。

Objective To explore the value of platelet-albumin-bilirubin score(PALBI),model for end stage liver disease(MELD)score,and international normalized ratio(INR)in predicting the prognosis of patients with liver cirrhosis and upper gastrointestinal hemorrhage.Methods A total of 211 patients with liver cirrhosis and upper gastrointestinal hemorrhage who were treated in Dongying People's Hospital,Capital Medical University between January 2017 and December 2020 were retrospectively selected.Among them,38 patients were within 28 days of the study.Patients who died(death group)and 173 patients were discharged after treatment improved(survival group).The PALBI,MELD scores and INR at admission of the two groups were compared,and the value of three indicators in predicting patient outcomes was evaluated using receiver operating characteristic curves.The related factors affecting the prognosis of patients were analyzed using Logistic model.Results The PALBI,MELD score,and INR value of the death group were(-1.44±0.43)points,(17.55±4.50)points,1.60±0.24,respectively,which were higher than those of the survival group[(-1.96±0.58)points,(11.68±2.77)points,1.25±0.22],and the differences were statistically significant(P<0.05).ROC curve results showed that the PALBI,MELD score,and INR value predicted the AUC value of the death of the patient were respectively 0.815,0.892,0.677.Logistic regression model,the results showed that patients with lung infection,spontaneous peritonitis,hepatic encephalopathy,increased Lac,PALBI,MELD score,and INR value were independent risk factors for poor prognosis(P<0.05).Conclusion The PALBI and MELD scores at admission have high clinical value in predicting the poor prognostic outcome of patients.Increased levels of PALBI,MELD and INR will increase the risk of poor prognostic outcomes for patients.