风险评分系统用于预测急性上部胃肠道出血的肝硬化患者的住院死亡率
Halim Bou Daher1,2, Mathew J Gregoski2,3, Don C Rockey1,2
1Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA.
概括
预测患有上部胃肠道出血 (UGIB) 的肝硬化患者的死亡率至关重要. 末期肝病模型 (MELD) 评分,特别是MELD-Na,在肝硬化患者的UGIB死亡率方面表现出强大的预测准确性.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 胃肠病学 胃肠病学
- 关键护理医学 关键护理医学
背景情况:
- 上部胃肠道出血 (UGIB) 对肝硬化患者具有重大风险.
- 准确预测这一群体的死亡率对于及时干预至关重要.
研究的目的:
- 开发和验证新的模型,并检查现有的模型,用于预测患有UGIB的肝硬化患者的死亡率.
- 确定这一患者队列中死亡率的关键预测因素.
主要方法:
- 2011-2018年间连续患有UGIB的肝硬化患者的分析.
- 使用了后勤回归,用于评分系统的接收器操作特征曲线 (AUROC) 下面区域分析,以及分类和回归树 (CART).
- 验证现有的评分系统,包括MELD-Na,MELD 3.0,MELD,Lyles-Rockey,AIMS65,Rockall和格拉斯哥-布拉奇福德等.
主要成果:
- 总共分析了333名患者,12%的患者已经过期.
- 与死亡率相关的因素包括查尔德-皮格C肝硬化,低血压,肝脑病变和肝细胞癌.
- 一种新型的模型结合了缩血压,MELD-Na和氨酸转移酶,显示出强大的预测能力 (AUROC 0.83).
- 在预测死亡的现有系统中,MELD-Na和MELD得分是最好的 (AUROC 0.81和0.80).
- 在CART分析中,MELD-Na被确定为最强的预测因子.
结论:
- 末期肝病模型 (MELD) 评分,特别是MELD-Na,是UGIB肝硬化患者死亡率的高度准确预测指标.
- 鉴于其成熟的使用,MELD得分被推作为临床实践中死亡率预测的主要工具.
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