The Prognosis Analysis of Liver Cirrhosis with Acute Variceal Bleeding and Validation of Current Prognostic Models: A Large Scale Retrospective Cohort Study
The Prognosis Analysis of Liver Cirrhosis with Acute Variceal Bleeding and Validation of Current Prognostic Models: A Large Scale Retrospective Cohort Study
复制标题
肝硬化伴急性静脉曲张出血的预后分析和当前预后模型的验证：大规模回顾性队列研究
DOI：
10.1155/2020/7372868
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发表时间：
2020-08-17
影响因子：
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通讯作者：
He, Shuixiang
中科院分区：
文献类型：
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作者：
Zhao, Yan;Ren, Mudan;He, Shuixiang
背景急性静脉曲张出血是肝硬化患者死亡的主要原因。这项大规模的回顾性队列研究旨在分析肝硬化和急性静脉曲张出血患者的预后，并验证当前的预后模型。方法2019年1月至2020年3月，入选肝硬化并急性静脉曲张出血患者。住院死亡的独立预后因素进行了Logistic回归分析。比较Child-Pugh评分、肝硬化急性消化道出血（CAGIB）评分、终末期肝病模型（MELD）评分和嗜中性淋巴细胞比率（NLR）评分的曲线下面积（AUC）。结果共连续评价了379例肝硬化和急性静脉曲张出血患者。大多数患者为男性（59.1%），所有患者的平均年龄为53.7 ± 1.3岁（范围14-89岁）。B型肝炎病毒（HBV）是肝硬化最常见的潜在病因（54.1%）。72例（19%）患者患有肝细胞癌。多因素Logistic回归分析显示，年龄、HCC、WBC、血清总胆红素、血清肌酐和ALT与院内死亡独立相关。住院死亡的OR值为1.066（95% CI 1.017-1.118，P = 0.008），7.19（95% CI 2.077-24.893，P = 0.001），1.123（95% CI 1.051-1.201，P = 0.001），1.014（95% CI 1.005-1.023，P = 0.003）、1.012（95% CI 1.004-1.021，P = 0.006）和1.005（95% CI 1.000-1.009，P = 0.036）。在整个HCC患者队列中，Child-Pugh、CAGIB、MELD和NLR评分的AUC分别为0.842（95% CI 0.801-0.878）、0.840（95% CI 0.799-0.876）、0.798（95% CI 0.754-0.838）和0.688（95% CI 0.639-0.735）。Child-Pugh评分与NLR评分比较差异有统计学意义（P = 0.0118），CAGIB评分与NLR评分比较差异有统计学意义（P = 0.0354）。结论Child-Pugh评分和CAGIB评分对肝硬化急性静脉曲张破裂出血患者预后的预测能力优于NLR评分。
Background Acute variceal bleeding is a major cause of death in liver cirrhosis. This large scale retrospective cohort study aims to analyze the prognosis of patients with cirrhosis and acute variceal bleeding and to validate the current prognostic models. Methods Patients with cirrhosis and acute variceal bleeding were enrolled from Jan 2019 to March 2020. The independent prognostic factors for in-hospital death were identified by logistic regression analyses. Area under curves (AUCs) was compared among Child-Pugh, cirrhosis acute gastrointestinal bleeding (CAGIB) score, and model for end-stage liver disease (MELD) and neutrophil-lymphocyte ratio (NLR) scores. Results Overall, 379 patients with liver cirrhosis and acute variceal bleeding were consecutively evaluated. The majority of the patients were males (59.1%) and the mean age of all patients were 53.7 ± 1.3 years (range 14-89). Hepatitis B virus (HBV) was the most common underlying cause of liver cirrhosis (54.1%). 72 (19%) patients had hepatocellular carcinoma. Multivariate logistic regression analyses showed that age, HCC, WBC, total serum bilirubin, serum creatinine, and ALT were independently associated with in-hospital death. And the odds ratios (ORs) for in-hospital death were 1.066 (95% CI 1.017-1.118, P = 0.008), 7.19 (95% CI 2.077-24.893, P = 0.001), 1.123 (95% CI 1.051-1.201, P = 0.001), 1.014 (95% CI 1.005-1.023, P = 0.003), 1.012 (95% CI 1.004-1.021, P = 0.006), and 1.005 (95% CI 1.000-1.009, P = 0.036), respectively. In the whole cohort with HCC patients, the AUCs of Child-Pugh, CAGIB, MELD and NLR scores were 0.842 (95% CI 0.801-0.878), 0.840 (95% CI 0.799-0.876), 0.798 (95% CI 0.754-0.838), and 0.688 (95% CI 0.639-0.735), respectively. The differences were statistically significant between Child-Pugh and NLR scores (P = 0.0118), and between CAGIB and NLR scores (P = 0.0354). Conclusion Child-Pugh and CAGIB scores showed better predictive performance for prognosis of patients with cirrhosis and acute variceal bleeding than NLR scores.