十一种临床评分预测肝硬化伴急性上消化道出血6周死亡风险

Eleven clinical scores predict 6-week mortality risk in liver cirrhosis with acute upper gastrointestinal bleeding

目的 判断常用的十一种临床评分对肝硬化伴急性上消化道出血患者6周死亡风险的预测能力。方法 收集2013年至2020年在上海交通大学医学院附属瑞金医院消化内科住院的肝硬化伴急性上消化道出血患者,并绘制ROC曲线判断不同模型或评分的预判能力。结果 共645例患者入组,未经倾向匹配评分(propensity score matching, PSM)的原始数据提示十一种评分方法只有谷草/谷丙转氨酶比值(aspartate/alanine aminotransferase ratio, AAR)不能很好地区分6周内发生死亡风险的患者(P=0.2)。经PSM匹配后数据提示Lok评分、NLR、Child-Pugh评分、MELD评分、白蛋白-胆红素评分(albumin-bilirubin score, ALBI)、血小板-白蛋白-胆红素评分(platelet-albumin-bilirubin score, PALBI)均可用于预测6周死亡风险(P<0.05)。结论 Child-Pugh评分、MELD评分、NLR、Lok评分、ALBI和PALBI在预测肝硬化伴急性上消化道出血患者6周死亡风险有较好的效果。

Objective To evaluate the predictive ability of 11 commonly used clinical scores for the risk of 6-week mortality risk in patients with liver cirrhosis and acute upper gastrointestinal bleeding.Methods Patients with acute upper gastrointestinal bleeding and liver cirrhosis who were hospitalized in the Department of Gastroenterology,Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from 2013 to 2020 were selected,and ROC curves were drawn to judge the predictive ability of different models or scores.Results A total of 645 patients were enrolled.Raw data without propensity score matching(PSM)suggested that only the aspartate/alanine aminotransferase ratio(AAR)could not well differentiate patients at risk of 6-week mortality(P=0.2).After PSM matching,the data indicated that Lok score,NLR,Child-Pugh score,MELD score,albumin-bilirubin score(ALBI),and platelet-albumin-bilirubin score(PALBI)could be used to predict the risk of 6-week mortality(P<0.05).Conclusion Child-Pugh score,MELD score,NLR,Lok score,ALBI and PALBI have good effects in predicting the 6-week mortality risk in patients with liver cirrhosis and acute upper gastrointestinal bleeding.