几种评分系统对肝硬化合并急性静脉曲张出血患者再出血及院内死亡率预后的价值

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY Gastroenterology Insights Pub Date : 2023-03-28 DOI:10.3390/gastroent14020011
Duong Quang Huy, N. V. Chung, Dinh Tien Dong
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引用次数: 0

摘要

背景:急性食管静脉曲张出血引起的上消化道出血是肝硬化患者的常见并发症和主要死亡原因。因此,预测风险,以便采用积极的管理,以防止再出血和死亡是至关重要的。目前,已经提出了许多预后评分系统,但需要研究找到一个有效的评分,可以在每个国家和人群的临床实践中应用。目的:比较ALBI(白蛋白-胆红素)、PALBI(血小板白蛋白-胆红素)、AIMS65、终末期肝病模型(MELD)和Child-Pugh评分(CPS)方法在预测肝硬化患者急性静脉曲张出血的早期再出血和住院死亡率方面的价值。研究对象和方法:我们对2020年9月至2022年5月在103军事医院重症监护室和108军事中心医院消化疾病治疗所接受治疗的肝硬化急性静脉曲张出血患者进行了横断面描述性研究。我们计算了ALBI、PALBI、AIMS65、MELD、Child-Pugh值,并将其与早期再出血率和住院死亡率进行了比较。然后,通过分析曲线下面积(AUC)来确定和比较预后价值。结果:222例急性食管静脉曲张出血患者符合纳入研究的条件。再出血率和住院死亡率分别为9.0%和6.8%。对于早期再出血的预后,ALBI和PALBI评分具有较好的预后价值(AUROC 0.74;95% CI: 0.63-0.85, AUROC为0.7;95% ci: 0.59-0.81;p = 0.004),而Child-Pugh、MELD、AIMS65评分的预后价值较小,AUROC < 0.70。对于院内死亡率的预后:ALBI、PALBI、MELD和AIMS65对院内死亡率均有较好的预测价值,AUROC分别为0.81 (95% CI: 0.68-0.93;P < 0.001);0.8 (95% ci: 0.69-0.91;p < 0.001);0.83 (95% ci: 0.72-0.93;P < 0.001);和0.82 (95% CI: 0.76-0.87, p < 0.001)。而Child-Pugh评分仅具有中等预后价值,AUROC为0.79 (95% CI: 0.66-0.92;P < 0.05)。然而,这些预后评分系统之间没有显著差异。结论:ALBI、PALBI、MELD和AIMS65评分对院内死亡率的预测价值相似,但对早期再出血预后的预测,只有ALBI和PALBI具有较好的预测价值。在预测早期再出血和住院死亡率方面,CPS不像其他评分那样显示预后价值。
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Value of Some Scoring Systems for the Prognosis of Rebleeding and In-Hospital Mortality in Liver Cirrhosis with Acute Variceal Bleeding
Background: Upper gastrointestinal (GI) hemorrhage, caused by acute esophageal variceal bleeding, is a common complication and a leading cause of death in patients with cirrhosis. Therefore, predicting the risk in order to employ an active management to prevent rebleeding and death is crucial. Currently, there are many prognostic scoring systems that have been proposed, but research is needed to find a valid score which can be applied in clinical practice in each country and population. Aims: To compare the value of ALBI (Albumin-Bilirubin), PALBI (Platelet Albumin-Bilirubin), AIMS65, model for end-stage liver disease (MELD), and Child–Pugh scores (CPS) approaches in predicting early rebleeding and in-hospital mortality of acute variceal bleeding in patients with cirrhosis. Subjects and methods: We performed a cross-sectional descriptive study on cirrhotic patients with acute variceal bleeding who were being treated at the Department of Gastroenterology, Intensive care unit—Military Hospital 103 and the Institute for Treatment of Digestive Diseases—108 Military Central Hospital from September 2020 to May 2022. We calculated ALBI, PALBI, AIMS65, MELD, Child–Pugh values and compared them with the rates of early rebleeding and in-hospital mortality. Then, determined and compared the prognostic value through an analysis of the area under the curve (AUC). Results: 222 patients with acute esophageal variceal bleeding were eligible for inclusion in the study. The rates of rebleeding and in-hospital mortality were 9.0% and 6.8%, respectively. Regarding the prognosis of early rebleeding, the ALBI and PALBI scores have good prognostic value (AUROC 0.74; 95% CI: 0.63–0.85 and AUROC 0.7; 95% CI: 0.59–0.81; p = 0.004, respectively), while the Child–Pugh, MELD, AIMS65 scores have little prognostic value, with AUROC < 0.70. Regarding prognosis of in-hospital mortality: the ALBI, PALBI, MELD and AIMS65 all have good value in predicting in-hospital mortality, with AUROC of 0.81 (95% CI: 0.68–0.93, respectively; p < 0.001); 0.8 (95% CI: 0.69–0.91; p <0.001); 0.83 (95% CI: 0.72–0.93; p < 0.001); and 0.82 (95% CI: 0.76–0.87, p < 0.001), respectively. While Child–Pugh score only has medium prognostic value, with AUROC 0.79 (95% CI: 0.66–0.92; p < 0.05). However, there was no significant difference between these prognostic scoring systems. Conclusion: the ALBI, PALBI, MELD and AIMS65 scores all had similar good value in predicting in-hospital mortality, but with early rebleeding prognosis, only ALBI and PALBI had good value. CPS does not show prognostic value like other scores, both in predicting early rebleeding and in-hospital mortality.
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来源期刊
Gastroenterology Insights
Gastroenterology Insights GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
2.80
自引率
3.40%
发文量
35
审稿时长
10 weeks
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