使用预后分数预测中期和长期存活率的预测,这些患者接受了无控制的水出血的救援TIPS
J E J Krige1, E G Jonas1, M Setshedi2
1Surgical Gastroenterology Unit, Groote Schuur Hospital, and Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa.
概括
预测得分如MELD和APACHE II准确地预测了救援后的生存时间. 尽管在94%的患者中控制了出血,但住院死亡率仍然很高,五年生存率不到四分之一.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 干预性放射学 干预性放射学
- 关键护理医学 关键护理医学
背景情况:
- 拯救性横性肝脏内移植系统分流 (sTIPS) 用于消除对内镜治疗无反应的血.
- 预测sTIPS后的结果对于患者管理和资源分配至关重要.
研究的目的:
- 评估在接受sTIPS的患者中短期 (90天) 和长期生存的确定的预后得分的预测价值.
- 为了确定与STIPS后死亡率相关的临床因素.
主要方法:
- 这项研究包括了34名患者,他们在1991年至2020年期间接受了针对水出血的sTIPS治疗.
- 计算了包括末期肝病 (MELD),MELD (MELDNa),APACHE II和Child-Pugh (C-P) 模型在内的预后得分.
- 使用卡普兰-梅尔曲线和考克斯比例危险模型来分析生存数据.
主要成果:
- 在94%的患者中,sTIPS可以控制出血,但住院死亡率为29.4%.
- 更高的CP值 (≥10),高CP值,MELD (≥15),MELD-Na (≥22) 和APACHE II (≥15) 分数显著预测了90天死亡率.
- 诸如三级炎,超过10单位输血,气球吸管,输管和内支持等因素与死亡率的增加有关.
- 五年生存率很低 (20.6%),在得分较低的患者中生存率显著提高 (C-P <10,MELD <15,MELD-Na <22,APACHE II <15).
结论:
- sTIPS在控制水出血方面有效,但具有很高的死亡风险.
- 预测得分系统 (MELD,MELDNa,APACHE II,CP) 是预测90天死亡率和STIPS后长期存活率的宝贵工具.
- 使用这些分数的风险分层可以帮助严重水出血患者的临床决策.
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