Burroughs Andrew K, Triantos Christos K, O'Beirne James, Patch David
The Royal Free Sheila Sherlock Liver Centre and Department of Surgery, University College London, Royal Free Hospital, Pond Street, London, UK.
Nat Clin Pract Gastroenterol Hepatol. 2009 Feb;6(2):72-3. doi: 10.1038/ncpgasthep1336. Epub 2008 Dec 17.
Despite improvements over the past 20 years in patient survival following episodes of acute variceal hemorrhage (AVH) secondary to cirrhosis, AVH is still associated with a high rate of mortality. The ability to predict which patients are at high risk of death, or which are not likely to respond to standard therapy at admission to hospital is important, as it enables the immediate initiation of vasoactive drugs, early endoscopic intervention and prophylactic antibiotics. This commentary discusses a study that attempts to predict early rebleeding and mortality after AVH in patients with cirrhosis using the Model for End-stage Liver Disease. In this study, the model was a significant predictor of mortality; however, several defects in the study's design limit the conclusions that can be drawn from it. The model described in this study is neither more useful, nor more accurate, than those previously published for the prediction of rebleeding and mortality in patients with AVH.
尽管在过去20年里，肝硬化继发急性静脉曲张出血（AVH）发作后的患者生存率有所提高，但AVH仍与高死亡率相关。预测哪些患者死亡风险高，或哪些患者在入院时不太可能对标准治疗有反应，这一能力很重要，因为它能使血管活性药物立即开始使用、早期进行内镜干预以及预防性使用抗生素。本评论讨论了一项试图使用终末期肝病模型预测肝硬化患者AVH后早期再出血和死亡率的研究。在这项研究中，该模型是死亡率的一个重要预测指标；然而，该研究设计中的几个缺陷限制了从中得出的结论。本研究中描述的模型在预测AVH患者再出血和死亡率方面，并不比之前发表的模型更有用或更准确。
