Le Moine O, Adler M, Bourgeois N, Delhaye M, Devière J, Gelin M, Vandermeeren A, Van Gossum A, Vereerstraeten A, Vereerstraeten P
Service Médico-Chirurgical d'Hépato-Gastroentérologie, Hôpital Erasme, Bruxelles, Belgium.
Gut. 1992 Oct;33(10):1381-5. doi: 10.1136/gut.33.10.1381.
Variceal haemorrhage in cirrhotic patients carries a high early mortality even when balloon tamponade or emergency sclerotherapy are applied. The aim of this study to identify patients dying within six weeks of their first variceal haemorrhage. One hundred and twenty one patients with parenchymal cirrhosis presenting with the first variceal bleeding episode between June 1983 and December 1988 were studied. Nineteen patients were excluded for various reasons. Emergency sclerotherapy was carried out in cases of active bleeding or where there were endoscopic signs of recent bleeding, and then regularly repeated afterwards. Of the 24 variables studied and included in a multivariate analysis using a logistic regression model, three had an independent prognostic value: encephalopathy, prothrombin time, and the number of blood units transfused within the 72 hours of time zero. The subsequent regression equation was able to predict 89% of the patients who will die and 97% of the patients who will still be alive six weeks after their first variceal haemorrhage treated by sclerotherapy. Pugh score was less discriminatory than these last three variables in terms of accuracy of adjustment, goodness of fit to the model, receiver operating characteristic curves, and percentage correct prediction. To measure the accuracy of the prediction rule, our model was applied to another series of 28 cirrhotic patients admitted with their first variceal bleeding during the next period (January 1989 to May 1990). Death and survival were correctly predicted in respectively 82% and 94% of the cases. The use of this score is recommended for the selection of patients with high early mortality after variceal bleeding despite sclerotherapy, and for the design of new therapeutic trials.
肝硬化患者的静脉曲张出血即便采用气囊压迫或紧急硬化疗法，早期死亡率仍很高。本研究旨在确定首次静脉曲张出血后六周内死亡的患者。对1983年6月至1988年12月间首次出现静脉曲张出血的121例实质性肝硬化患者进行了研究。19例患者因各种原因被排除。对于有活动性出血或内镜检查有近期出血迹象的病例，实施紧急硬化疗法，之后定期重复进行。在使用逻辑回归模型进行多变量分析的24个变量中，有三个具有独立的预后价值：肝性脑病、凝血酶原时间以及零时72小时内输注的血单位数量。随后的回归方程能够预测89%的死亡患者以及97%的首次静脉曲张出血经硬化疗法治疗六周后仍存活的患者。就调整准确性、模型拟合优度、受试者工作特征曲线以及正确预测百分比而言，Pugh评分的区分度低于这最后三个变量。为评估预测规则的准确性，我们将模型应用于下一个时期（1989年1月至1990年5月）收治的另一组28例首次静脉曲张出血的肝硬化患者。分别正确预测了82%的死亡病例和94%的存活病例。推荐使用该评分来选择尽管接受了硬化疗法但静脉曲张出血后早期死亡率高的患者，并用于设计新的治疗试验。
