A revised natural history model for primary sclerosing cholangitis.
A revised natural history model for primary sclerosing cholangitis.
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DOI：
10.4065/75.7.688
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发表时间：
1997-02
影响因子：
8.9
通讯作者：
W. R. Kim;T. Therneau;R. Wiesner;J. Poterucha;J. Benson;M. Malinchoc;N. LaRusso;K. Lindor;E. Dickson
中科院分区：
文献类型：
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作者：
W. R. Kim;T. Therneau;R. Wiesner;J. Poterucha;J. Benson;M. Malinchoc;N. LaRusso;K. Lindor;E. Dickson
目的描述原发性硬化性胆管炎（PSC）的自然病程模型，该模型基于常规临床表现和检查结果，无需肝活检。患者和方法使用考克斯比例风险分析，我们创建了一个生存模型的基础上，405例PSC患者从5个临床中心。通过将其应用于未包括在模型创建中的124名患者，对模型进行了独立验证。结果基于对405例患者的多变量分析，风险评分由以下公式定义：R = 0.03（年龄[y]）+ 0.54 loge（胆红素[mg/dL]）+ 0.54 loge（天冬氨酸转氨酶[U/L]）+ 1.24（静脉曲张出血[0/1]）- 0.84（白蛋白[g/dL]）。风险评分用于获得长达4年随访的生存率估计值。将该模型应用于一个独立的124例患者组，结果显示估计生存率与实际生存率之间存在良好的相关性。结论：估计PSC患者生存率的新模型包括更具重现性的变量（年龄、胆红素、白蛋白、天冬氨酸转氨酶和静脉曲张出血史），其准确性与以前的模型相当，并且无需进行肝活检。
OBJECTIVE To describe a natural history model for primary sclerosing cholangitis (PSC) that is based on routine clinical findings and test results and eliminates the need for liver biopsy. PATIENTS AND METHODS Using the Cox proportional hazards analysis, we created a survival model based on 405 patients with PSC from 5 clinical centers. Independent validation of the model was undertaken by applying it to 124 patients who were not included in the model creation. RESULTS Based on the multivariate analysis of 405 patients, a risk score was defined by the following formula: R = 0.03 (age [y]) + 0.54 loge (bilirubin [mg/dL]) + 0.54 loge (aspartate aminotransferase [U/L]) + 1.24 (variceal bleeding [0/1]) - 0.84 (albumin [g/dL]). The risk score was used to obtain survival estimates up to 4 years of follow-up. Application of this model to an independent group of 124 patients showed good correlation between estimated and actual survival. CONCLUSIONS A new model to estimate patient survival in PSC includes more reproducible variables (age, bilirubin, albumin, aspartate aminotransferase, and history of variceal bleeding), has accuracy comparable to previous models, and obviates the need for a liver biopsy.