Sempere L, Palazón J M, Sánchez-Payá J, Pascual S, de Madaria E, Poveda M J, Carnicer F, Zapater P, Pérez-Mateo M
Epidemiology Service, Hospital General Universitario, Alicante, Spain.
Rev Esp Enferm Dig. 2009 Apr;101(4):236-48.
to evaluate the efficacy of various indicators in predicting short- and long-term survival in patients with cirrhosis and acute variceal bleeding.
prognostic indicators were calculated for a cohort of 201 cirrhotic patients with acute variceal bleeding hospitalized in our center, a third-level teaching hospital. The studied variables were: age, sex, etiology of cirrhosis, endoscopic findings, previous variceal bleeding episodes, human immunodeficiency virus (HIV) infection, hepatocellular carcinoma (HCC), infection during episode, and Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease (MELD) scores within 24 hours of bleeding onset. Patients were followed up for at least 6 months until death, liver transplantation, or end of observation.
median follow-up was 66.85 weeks (range 0-432.4). The 6-week, 3-month, 12-month and 36-month mortality rates were 22.9, 24.9, 34.3, and 39.8%, respectively. Age >= 65 years, presence of HCC, CTP score >=10, and MELD score >= 18 were the variables associated with mortality in the multivariate analysis. The accuracy of MELD scores as predictors of 6-week, 3-month, 12-month, and 36-month mortality was better than that of CTP scores (c-statistics: 6 week MELD 0.804, CTP 0.762; 3-month MELD 0.794, CTP 0.760; 12-month MELD 0.766, CTP 0.741; 36 month MELD 0.737, CTP 0.717).
MELD and CTP scores together with age and a diagnosis of hepatocellular carcinoma are useful indicators to assess the short- and long-term prognosis of patients with acute variceal bleeding.
评估各项指标预测肝硬化急性静脉曲张出血患者短期和长期生存的疗效。
对在我们中心（一家三级教学医院）住院的201例肝硬化急性静脉曲张出血患者队列计算预后指标。研究变量包括：年龄、性别、肝硬化病因、内镜检查结果、既往静脉曲张出血发作史、人类免疫缺陷病毒（HIV）感染、肝细胞癌（HCC）、出血期间感染以及出血发作后24小时内的Child-Turcotte-Pugh（CTP）评分和终末期肝病模型（MELD）评分。对患者进行至少6个月的随访，直至死亡、肝移植或观察结束。
中位随访时间为66.85周（范围0 - 432.4周）。6周、3个月、12个月和36个月的死亡率分别为22.9%、24.9%、34.3%和39.8%。多因素分析中，年龄≥65岁、存在肝细胞癌、CTP评分≥10以及MELD评分≥18是与死亡率相关的变量。MELD评分作为6周、3个月、12个月和36个月死亡率预测指标的准确性优于CTP评分（c统计量：6周时MELD为0.804，CTP为0.762；3个月时MELD为0.794，CTP为0.760；12个月时MELD为0.766，CTP为0.741；36个月时MELD为0.737，CTP为0.717）。
MELD和CTP评分以及年龄和肝细胞癌诊断是评估急性静脉曲张出血患者短期和长期预后的有用指标。
