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终末期肝病模型(MELD)在预测与食管静脉曲张破裂出血相关的住院死亡率方面优于Child-Pugh评分。

Model for end stage of liver disease (MELD) is better than the Child-Pugh score for predicting in-hospital mortality related to esophageal variceal bleeding.

作者信息

Flores-Rendón Angel Ricardo, González-González José Alberto, García-Compean Diego, Maldonado-Garza Héctor Jesús, Garza-Galindo Aldo Azael

机构信息

Facultad de Medicina y Centro Regional para el Estudio de Enfermedades Digestivas, (CREED) Hospital Universitario, UANL, Monterrey, N.L. México.

出版信息

Ann Hepatol. 2008 Jul-Sep;7(3):230-4.

Abstract

AIM

The Child Pugh and MELD are good methods for predicting mortality in patients with chronic liver disease. We investigated their performance as risk factors for failure to control bleeding, in-hospital overall mortality and death related to esophageal variceal bleeding episodes.

METHODS

From a previous collected database, 212 cirrhotic patients with variceal bleeding admitted to our hospital were studied. The predictive capability of Child Pugh and MELD scores were compared using c statistics.

RESULTS

The Child-Pugh and MELD scores showed marginal capability for predicting failure to control bleeding (the area under receiver operating characteristics curve (AUROC) values were < 0.70 for both). The AUROC values for predicting in-hospital overall mortality of Child-Pugh and MELD score were similar: 0.809 (CI 95%, 0.710 - 0.907) and 0.88 (CI 95% 0.77- 0.99,) respectively. There was no significant difference between them (p > 0.05). The AUROC value of MELD for predicting mortality related to variceal bleeding was higher than the Child-Pugh score: 0.905 (CI 95% 0.801-1.00) vs 0.794 (CI 95% 0.676 - 0.913) respectively (p < 0.05).

CONCLUSIONS

MELD and Child-Pugh were not efficacious scores for predicting failure to control bleeding. The Child-Pugh and MELD scores had similar capability for predicting in-hospital overall mortality. Nevertheless, MELD was significantly better than Child-Pugh score for predicting in-hospital mortality related to variceal bleeding.

摘要

目的

儿童终末期肝病评分(Child Pugh)和终末期肝病模型(MELD)是预测慢性肝病患者死亡率的良好方法。我们研究了它们作为控制出血失败、院内总死亡率和与食管静脉曲张出血发作相关死亡的风险因素的表现。

方法

从先前收集的数据库中,研究了我院收治的212例肝硬化静脉曲张出血患者。使用c统计量比较Child Pugh和MELD评分的预测能力。

结果

Child-Pugh和MELD评分在预测控制出血失败方面能力有限(两者的受试者工作特征曲线下面积(AUROC)值均<0.70)。Child-Pugh和MELD评分预测院内总死亡率的AUROC值相似:分别为0.809(95%CI,0.710 - 0.907)和0.88(95%CI 0.77 - 0.99)。两者之间无显著差异(p>0.05)。MELD预测与静脉曲张出血相关死亡率的AUROC值高于Child-Pugh评分:分别为0.905(95%CI 0.801 - 1.00)和0.794(95%CI 0.676 - 0.913)(p<0.05)。

结论

MELD和Child-Pugh评分在预测控制出血失败方面效果不佳。Child-Pugh和MELD评分在预测院内总死亡率方面能力相似。然而,在预测与静脉曲张出血相关的院内死亡率方面,MELD明显优于Child-Pugh评分。

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