Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt
Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt
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DOI：
10.1136/gut.52.6.879
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发表时间：
2003-06-01
期刊：
影响因子：
24.5
通讯作者：
Peck-Radosavljevic, M
中科院分区：
文献类型：
--
作者：
Angermayr, B;Cejna, M;Peck-Radosavljevic, M
背景：在接受经颈静脉肝内门静脉系统分流术（TIPS）的患者中，预后评分可以识别出预后较差的患者，甚至可以识别出明显的生存获益患者。Child-Pugh评分（CPS）已经建立，但一些缺陷导致了终末期肝病（MELD）模型的发展。目的：本研究的目的是比较CPS和MELD的预测能力，验证原始的MELD公式，并评估在研究环境外两种预后评分中使用的决定因素的预测价值。患者：共有501例患者接受了选择性TIPS植入，475例患者符合纳入标准。方法：回顾性分析1991年至2001年在奥地利维也纳一所大学医院和四所社区医院接受选择性TIPS治疗的所有患者的资料。主要统计检验为Cox比例风险回归模型、log rank检验、Kaplan-Meier分析和一致性c统计。结果：中位随访时间为5.2年，中位生存期为4.6年。在随访期间，230例患者死亡，其中75例在TIPS放置后3个月内死亡。在逐步比例风险分析中，死亡的独立预测因子是肌酐水平、胆红素水平、年龄和难治性腹水。在逐步Cox模型中，MELD在预测生存方面更好，但在1个月、3个月和1年的c统计中，这两个评分具有相同的预测能力。肾功能是生存最强的独立预测因子。结论：虽然MELD是多变量分析中总生存的主要预测因子，但c统计显示，这两种评分都可以用于TIPS患者，准确率相同。为了评估TIPS植入术患者的预后，似乎没有什么理由替代已建立的Child-Pugh评分。
Background: In patients undergoing transjugular intrahepatic portosystemic shunt (TIPS), prognostic scores may identify those with a poor prognosis or even those with a clear survival benefit. The Child-Pugh score (CPS) is well established but several drawbacks have led to development of the model of end stage liver disease (MELD).Aim: The aim of the study was to compare the predictive power of CPS and MELD, to validate the original MELD formula, and to assess the predictive value of the determinants used in the two prognostic scores outside of a study setting.Patients: A total of 501 patients underwent elective TIPS placement and 475 patients fulfilled the inclusion criteria.Methods: Data of all patients undergoing elective TIPS in one university hospital and four community hospitals in Vienna, Austria, between 1991 and 2001, were analysed retrospectively. The main statistical tests were Cox proportional hazards regression model, the log rank test, Kaplan-Meier analysis, and concordance c statistics.Results: Median follow up was 5.2 years and median survival was 4.6 years. During follow up, 230 patients died, 75 within three months after TIPS placement. In stepwise proportional hazards analyses, independent predictors of death were creatinine level, bilirubin level, age, and refractory ascites. MELD was better in predicting survival in a stepwise Cox model but both scores were equally predictive in c statistics for one month, three month, and one year survival. Renal function was the strongest independent predictor of survival.Conclusions: Although MELD was the primary predictor of overall survival in multivariate analysis, c statistics showed that both scores can be used for patients undergoing TIPS with equal accuracy. For assessing prognosis in patients undergoing TIPS implantation, there seems little reason to replace the well established Child-Pugh score.