Model for end-stage liver disease score versus Child score in predicting the outcome of surgical procedures in patients with cirrhosis
Model for end-stage liver disease score versus Child score in predicting the outcome of surgical procedures in patients with cirrhosis
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DOI：
10.3748/wjg.14.1774
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发表时间：
2008-03-21
影响因子：
4.3
通讯作者：
Rutherford, Robin E.
中科院分区：
文献类型：
--
作者：
Hoteit, Maarouf A.;Ghazale, Amaar H.;Rutherford, Robin E.
目的：确定肝硬化患者接受手术的结果的影响因素，并比较的能力Child-Turcotte-Pugh（CTP）和模型的终末期肝病（MELD）评分预测outcome.METHODS：我们回顾了195例肝硬化患者接受手术在两个教学医院在五年内的图表。死亡或肝功能失代偿的联合终点被认为是主要终点。结果：达到终点的患者有较高的MELD评分，较高的CTP评分，更有可能经历了紧急程序。在接受择期外科手术的患者中，达到终点的患者与未达到终点的患者之间的平均MELD（12.8 +/- 3.9 vs 12.6 +/- 4.7，P = 0.9）或平均CTP（7.6 +/- 1.2 vs 7.7 +/- 1.7，P = 0.8）无统计学显著差异。在紧急手术的情况下，达到终点的患者的两个平均评分均较高（MELD：22.4 +/- 8.7 vs 15.2 +/- 6.4，P = 0.0007; CTP：9.9 +/- 1.8 vs 8.5 +/- 1.8，P = 0.008）。MELD和CTP评分在预测急诊手术结果方面的表现仅为一般，两者之间无显著差异（MELD的AUC = 0.755 +/- 0.066 vs CTP的AUC = 0.696 +/- 0.070，P = 0.3）。结论：CTP和MELD评分在预测急诊手术结果方面表现相同，但仅为一般。需要更大规模的研究来更好地确定能够预测肝硬化患者选择性外科手术结果的因素。(c)2008年WJG。All rights reserved.
AIM: To determine factors affecting the outcome of patients with cirrhosis undergoing surgery and to compare the capacities of the Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) score to predict that outcome.METHODS: We reviewed the charts of 195 patients with cirrhosis who underwent surgery at two teaching hospitals over a five-year period. The combined endpoint of death or hepatic decompensation was considered to be the primary endpoint.RESULTS: Patients who reached the endpoint had a higher MELD score, a higher CTP score and were more likely to have undergone an urgent procedure. Among patients undergoing elective surgical procedures, no statistically significant difference was noted in the mean MELD (12.8 +/- 3.9 vs 12.6 +/- 4.7, P = 0.9) or in the mean CTP (7.6 +/- 1.2 vs 7.7 +/- 1.7, P = 0.8) between patients who reached the endpoint and those who did not. Both mean scores were higher in the patients reaching the endpoint in the case of urgent procedures (MELD: 22.4 +/- 8.7 vs 15.2 +/- 6.4, P = 0.0007; CTP: 9.9 +/- 1.8 vs 8.5 +/- 1.8, P = 0.008). The performances of the MELD and CTP scores in predicting the outcome of urgent surgery were only fair, without a significant difference between them (AUC = 0.755 +/- 0.066 for MELD vs AUC = 0.696 +/- 0.070 for CTP, P = 0.3).CONCLUSION: The CTP and MELD scores performed equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis. (c) 2008 WJG. All rights reserved.