Tsai Ming-Hung, Chen Yung-Chang, Ho Yu-Pin, Fang Ji-Tseng, Lien Jau-Min, Chiu Cheng-Tang, Liu Nai-Jen, Chen Pang-Chi
Division of Gastroenterology, Chang Gung Memorial Hospital, Taipei, Taiwan.
J Clin Gastroenterol. 2003 Sep;37(3):251-7. doi: 10.1097/00004836-200309000-00011.
This study was conducted to assess and compare the accuracy of Child-Pugh classification and organ system failure (OSF) scores, obtained on the first day of ICU admission, in predicting the hospital mortality in critically ill cirrhotic patients.
Cirrhotic patients admitted to the medical intensive care unit (ICU) are associated with high mortality rates. The prognosis of critically ill cirrhotic patients is determined by the extent of hepatic and extrahepatic organ dysfunction.
A total of 111 patients diagnosed with liver cirrhosis were admitted to medical ICU from July 2001 to June 2002. Information considered necessary to compute the Child-Pugh and OSF scores on the first day of ICU admission was prospectively collected.
The overall hospital mortality rate was 64.9%. Liver disease was most commonly attributed to hepatitis B viral infection. The OSF scores demonstrate a good fit using the Hosmer and Lemeshow goodness-of-fit test. Meanwhile, by using the areas under receiver operating characteristic (AUROC) curve, the OSF scores demonstrated an excellent discriminative power (AUROC 0.901), whereas the performance of Child-Pugh scores is clearly poorer (AUROC 0.748).
This investigation confirms that the prognosis for cirrhotic patients admitted to ICU is grave. The OSF score is a simple, reproducible, and easily applied tool with excellent prognostic abilities that can provide objective information for patients' families and physicians and supplement the clinical judgment of prognosis.
本研究旨在评估并比较重症肝硬化患者入住重症监护病房（ICU）首日获得的Child-Pugh分类和器官系统衰竭（OSF）评分在预测医院死亡率方面的准确性。
入住内科重症监护病房的肝硬化患者死亡率较高。重症肝硬化患者的预后取决于肝和肝外器官功能障碍的程度。
2001年7月至2002年6月，共有111例诊断为肝硬化的患者入住内科ICU。前瞻性收集了计算入住ICU首日Child-Pugh和OSF评分所需的必要信息。
总体医院死亡率为64.9%。肝病最常见的病因是乙型肝炎病毒感染。使用Hosmer和Lemeshow拟合优度检验，OSF评分显示出良好的拟合度。同时，通过使用受试者工作特征（AUROC）曲线下面积，OSF评分显示出优异的判别能力（AUROC 0.901），而Child-Pugh评分的表现明显较差（AUROC 0.748）。
本研究证实，入住ICU的肝硬化患者预后严重。OSF评分是一种简单、可重复且易于应用的工具，具有出色的预后能力，可为患者家属和医生提供客观信息，并补充预后的临床判断。
