一种生化和临床模型在预测终末期肝病患者个体生存情况中的应用。

Application of a biochemical and clinical model to predict individual survival in patients with end-stage liver disease.

作者信息

Gomez Eduardo Vilar, Bertot Luis Calzadilla, Oramas Bienvenido Gra, Soler Enrique Arus, Navarro Raimundo Llanio, Elias Javier Diaz, Jiménez Oscar Villa, Abreu Vazquez Maria del Rosario

机构信息

National Institute of Gastroenterology, Vedado, Havana, Cuba.

出版信息

World J Gastroenterol. 2009 Jun 14;15(22):2768-77. doi: 10.3748/wjg.15.2768.

DOI:10.3748/wjg.15.2768

PMID:19522028

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2695893/

Abstract

AIM

To investigate the capability of a biochemical and clinical model, BioCliM, in predicting the survival of cirrhotic patients.

METHODS

We prospectively evaluated the survival of 172 cirrhotic patients. The model was constructed using clinical (ascites, encephalopathy and variceal bleeding) and biochemical (serum creatinine and serum total bilirubin) variables that were selected from a Cox proportional hazards model. It was applied to estimate 12-, 52- and 104-wk survival. The model's calibration using the Hosmer-Lemeshow statistic was computed at 104 wk in a validation dataset. Finally, the model's validity was tested among an independent set of 85 patients who were stratified into 2 risk groups (low risk <or= 8 and high risk > 8).

RESULTS

In the validation cohort, all measures of fit, discrimination and calibration were improved when the biochemical and clinical model was used. The proposed model had better predictive values (c-statistic: 0.90, 0.91, 0.91) than the Model for End-stage Liver Disease (MELD) and Child-Pugh (CP) scores for 12-, 52- and 104-wk mortality, respectively. In addition, the Hosmer-Lemeshow (H-L) statistic revealed that the biochemical and clinical model (H-L, 4.69) is better calibrated than MELD (H-L, 17.06) and CP (H-L, 14.23). There were no significant differences between the observed and expected survival curves in the stratified risk groups (low risk, P = 0.61; high risk, P = 0.77).

CONCLUSION

Our data suggest that the proposed model is able to accurately predict survival in cirrhotic patients.

摘要

目的

研究生化与临床模型BioCliM预测肝硬化患者生存率的能力。

方法

我们前瞻性评估了172例肝硬化患者的生存率。该模型使用从Cox比例风险模型中选取的临床（腹水、肝性脑病和静脉曲张出血）和生化（血清肌酐和血清总胆红素）变量构建而成。它被用于估计12周、52周和104周的生存率。在一个验证数据集中，使用Hosmer-Lemeshow统计量在104周时对该模型进行校准。最后，在一组独立的85例患者中对该模型的有效性进行测试，这些患者被分为2个风险组（低风险≤8和高风险＞8）。

结果

在验证队列中，使用生化与临床模型时，所有拟合、区分度和校准指标均得到改善。对于12周、52周和104周死亡率，所提出的模型分别比终末期肝病模型（MELD）和Child-Pugh（CP）评分具有更好的预测价值（c统计量：0.90、0.91、0.91）。此外，Hosmer-Lemeshow（H-L）统计量显示，生化与临床模型（H-L，4.69）比MELD（H-L，17.06）和CP（H-L，14.23）校准得更好。在分层风险组中，观察到的和预期的生存曲线之间没有显著差异（低风险，P = 0.61；高风险，P = 0.77）。