Soultati Aspasia S, Dourakis Spyridon P, Alexopoulou Alexandra, Deutsch Melanie, Vasilieva Larissa, Archimandritis Athanasios J
2nd Department of Internal Medicine, University of Athens Medical School, Hippokration General Hospital, Greece.
World J Gastroenterol. 2006 Jul 7;12(25):4020-5. doi: 10.3748/wjg.v12.i25.4020.
To validate the statistic utility of both the Maddrey Discriminant Function score and the Model for End-Stage Liver Disease as predictors of short term (30 d and 90 d) mortality in patients with alcoholic hepatitis and to assess prognostic factors among clinical characteristics and laboratory variables of patients with alcoholic hepatitis.
Thirty-four patients with the diagnosis of alcoholic hepatitis admitted to Hippokration University Hospital of Athens from 2000 to 2005 were assessed in the current retrospective study and a statistical analysis was conducted.
30- and 90-d mortality rates were reported at 5.9% (2/34) and 14.7% (5/34), respectively. Significant correlation was demonstrated for the Model for End-Stage Liver Disease (P30 = 0.094, P90 = 0.046) and the Maddrey Discriminant Function score (P30 = 0.033, P90 = 0.038) with 30- and 90-d mortality whereas a significant association was also established for alanine aminotransferase (P = 0.057), fibrin degradation products (P = 0.048) and C-reactive protein (P = 0.067) with 90-d mortality. For 30-d mortality the Area Under the Curve was 0.969 (95%CI: 0.902-1.036, P = 0.028) for the Model for End-Stage Liver Disease score and 0.984 (95%CI: 0.942-1.027, P = 0.023) for the Maddrey Discriminant Function score with the optimal cut off point of 30.5 (sensitivity 1, specificity 0.937) and 108.68 (sensitivity 1, specificity 0.969), respectively. Accordingly, for 90-d mortality the Area Under the Curve was 0.762 (95%CI: 0.559-0.965, P = 0.065) for the Model for End-Stage Liver Disease score and 0.752 (95%CI: 0.465-1.038, P = 0.076) for the Maddrey Discriminant Function score with the optimal cut off point of 19 (sensitivity 0.6, specificity 0.6) and 92 (sensitivity 0.6, specificity 0.946), respectively. The observed Kaplan Meier survival rates for different score-categories were compared with log-rank tests and higher score values were correlated with a lower survival.
Equivalency of the Model for End-Stage Liver Disease and the Maddrey Discriminant Function score is implied by the current study, verified by the plotted Receiver Operative Curves and the estimated survival rates. A statistically significant utility of C-reactive protein, fibrin degradation products and alanine aminotransferase as independent predictors of 90-d mortality has also been verified.
验证终末期肝病模型（Model for End-Stage Liver Disease，MELD）评分和Maddrey判别函数评分在酒精性肝炎患者短期（30天和90天）死亡率预测中的统计学效用，并评估酒精性肝炎患者临床特征和实验室指标中的预后因素。
在这项回顾性研究中，对2000年至2005年入住雅典希波克拉底大学医院且诊断为酒精性肝炎的34例患者进行评估，并进行统计分析。
报告的30天和90天死亡率分别为5.9%（2/34）和14.7%（5/34）。终末期肝病模型（P30 = 0.094，P90 = 0.046）和Maddrey判别函数评分（P30 = 0.033，P90 = 0.038）与30天和90天死亡率显著相关，而丙氨酸氨基转移酶（P = 0.057）、纤维蛋白降解产物（P = 0.048）和C反应蛋白（P = 0.067）与90天死亡率也显著相关。对于30天死亡率，终末期肝病模型评分的曲线下面积为0.969（95%可信区间：0.902 - 1.036，P = 0.028），Maddrey判别函数评分的曲线下面积为0.984（95%可信区间：0.942 - 1.027，P = 0.023），最佳截断点分别为30.5（敏感性1，特异性0.937）和108.68（敏感性1，特异性0.969）。因此，对于90天死亡率，终末期肝病模型评分的曲线下面积为0.762（95%可信区间：0.559 - 0.965，P = 0.065），Maddrey判别函数评分的曲线下面积为0.752（95%可信区间：0.465 - 1.038，P = 0.076），最佳截断点分别为19（敏感性0.6，特异性0.6）和92（敏感性0.6，特异性0.946）。通过对数秩检验比较不同评分类别观察到的Kaplan-Meier生存率，较高的评分值与较低的生存率相关。
本研究表明终末期肝病模型和Maddrey判别函数评分相当，通过绘制的受试者工作特征曲线和估计的生存率得到验证。C反应蛋白、纤维蛋白降解产物和丙氨酸氨基转移酶作为90天死亡率独立预测因子的统计学显著效用也得到了验证。
