Attia K A, Ackoundou-N'guessan K C, N'dri-Yoman A T, Mahassadi A K, Messou E, Bathaix Y F, Kissi Y H
Service of Hepatology, Gastroenterology and General Medicine, Yopougon Teaching Hospital, Abidjan, Ivory Coast.
World J Gastroenterol. 2008 Jan 14;14(2):286-91. doi: 10.3748/wjg.14.286.
To compare the performance of the Child-Pugh-Turcott (CPT) score to that of the model for end-stage liver disease (MELD) score in predicting survival of a retrospective cohort of 172 Black African patients with cirrhosis on a short and mid-term basis.
Univariate and multivariate (Cox model) analyses were used to identify factors related to mortality. Relationship between the two scores was appreciated by calculating the correlation coefficient. The Kaplan Meier method and the log rank test were used to elaborate and compare survival respectively. The Areas Under the Curves were used to compare the performance between scores at 3, 6 and 12 mo.
The study population comprised 172 patients, of which 68.9% were male. The mean age of the patient was 47.5 +/- 13 years. Hepatitis B virus infection was the cause of cirrhosis in 70% of the cases. The overall mortality was 31.4% over 11 years of follow up. Independent factors significantly associated with mortality were: CPT score (HR = 3.3, 95% CI [1.7-6.2]) (P < 0.001) (stage C vs stage A-B); Serum creatine (HR = 2.5, 95% CI [1.4-4.3]) (P = 0.001) (Serum creatine > 1.5 mg/dL versus serum creatine < 1.5 mg/dL); MELD score (HR = 2.9, 95% CI [1.63-5.21]) (P < 0.001) (MELD > 21 vs MELD < 21). The area under the curves (AUC) that predict survival was 0.72 and 0.75 at 3 mo (P = 0.68), 0.64 and 0.62 at 6 mo (P = 0.67), 0.69 and 0.64 at 12 mo (P = 0.38) respectively for the CPT score and the MELD score.
The CPT score displays the same prognostic significance as does the MELD score in black African patients with cirrhosis. Moreover, its handling appears less cumbersome in clinical practice as compared to the latter.
比较Child-Pugh-Turcott（CPT）评分与终末期肝病模型（MELD）评分在预测172例非洲黑人肝硬化患者短期和中期生存情况方面的表现。
采用单因素和多因素（Cox模型）分析来确定与死亡率相关的因素。通过计算相关系数来评估两个评分之间的关系。采用Kaplan Meier法和对数秩检验分别阐述和比较生存率。使用曲线下面积来比较3、6和12个月时各评分的表现。
研究人群包括172例患者，其中68.9%为男性。患者的平均年龄为47.5±13岁。70%的病例中，乙型肝炎病毒感染是肝硬化的病因。在11年的随访中，总死亡率为31.4%。与死亡率显著相关的独立因素有：CPT评分（HR = 3.3，95%CI[1.7 - 6.2]）（P < 0.001）（C期与A - B期）；血清肌酐（HR = 2.5，95%CI[1.4 - 4.3]）（P = 0.001）（血清肌酐>1.5mg/dL与血清肌酐<1.5mg/dL）；MELD评分（HR = 2.9，95%CI[1.63 - 5.21]）（P < 0.001）（MELD>21与MELD<21）。CPT评分和MELD评分预测生存的曲线下面积（AUC）在3个月时分别为0.72和0.75（P = 0.68），6个月时分别为0.64和0.62（P = 0.67），12个月时分别为0.69和0.64（P = 0.38）。
在非洲黑人肝硬化患者中，CPT评分与MELD评分具有相同的预后意义。此外，在临床实践中，CPT评分的应用似乎比MELD评分更简便。
