Wang H, Liu S
Department of Infectious Diseases, Zhejiang Provincial People's Hospital, Hangzhou 310014, China.
Zhonghua Gan Zang Bing Za Zhi. 2000 Dec;8(6):348-9.
To evaluate the prognostic value of APARCHEIII (acute physiology, age and chronic health evaluation) score system for cirrhosis patients.
The clinic data of 205 cirrhotic patients were prospectively collected, APARCHEIII and Child-Pugh scores for each patient were recorded on admission day. Using discrimination analysis, the predictive accuracy of the two systems was investigated.
The complication included GI bleeding (15.6%), encephalopathy (10.6%), hepatorenal syndrome (8.8%), primary liver carcinoma (8.8%), and spontaneous bacterial peritonitis (4.8%). Fifty patients (24%) died. The major cause of death was GI bleeding (40%), hepatorenal syndrome (34%), hepatic failure (20%) and spontaneous bacterial peritonitis (6%). APARCHEIII and Child score for survivors was 19.3+/-8.6 and 7.4+/-1.8, significantly lower than those for nonsurvivors (47.9+/-20.1 and 10.6+/-2.4). APARCHEIII score system correctly predicted 82.3% of death cases vs 72.7% for Child system. When combined with the information of ascites and prothrombin prolongation time, 88.2% cases could be correctly identified in advance.
The APARCHEIII score system is a more efficient and accurate predictive system than Child for prognosticating short-term survival of cirrhotic patients and worth use in clinic.
评估急性生理与慢性健康状况评分系统（APACHEIII）对肝硬化患者的预后价值。
前瞻性收集205例肝硬化患者的临床资料，记录每位患者入院当天的APACHEIII评分和Child-Pugh评分。采用判别分析研究这两种评分系统的预测准确性。
并发症包括消化道出血（15.6%）、肝性脑病（10.6%）、肝肾综合征（8.8%）、原发性肝癌（8.8%）和自发性细菌性腹膜炎（4.8%）。50例患者（24%）死亡。主要死亡原因是消化道出血（40%）、肝肾综合征（34%）、肝衰竭（20%）和自发性细菌性腹膜炎（6%）。存活患者的APACHEIII评分和Child评分分别为19.3±8.6和7.4±1.8，显著低于非存活患者（47.9±20.1和10.6±2.4）。APACHEIII评分系统正确预测了82.3%的死亡病例，而Child评分系统为72.7%。当结合腹水和凝血酶原延长时间的信息时，88.2%的病例可以提前正确识别。
对于肝硬化患者短期生存的预后评估，APACHEIII评分系统比Child评分系统更有效、准确，值得临床应用。
