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[终末期肝病模型(MELD)还是马德雷评分(Maddrey)?酒精性中毒性肝炎患者两种预后模型的比较]

[MELD or Maddrey?: comparison of two prognosis models in patients with alcohol toxic hepatitis].

作者信息

Zapata-Irrisón L, Jurado-Nuñez J J, Altamirano-Gómez J T

机构信息

Servicio de Gastroenterología y Dirección de Enseñanza e Investigación, Hospital Juárez de México, México, Distrito Federal.

出版信息

Rev Gastroenterol Mex. 2008;73(2):57-62.

Abstract

BACKGROUND

The toxic hepatitis is the most common manifestation of acute liver disease in patient with alcohol. In these patients the discriminatory function index (DFI) > 32, has been associated with a mortality rate of up to 50%. MELD is a scale that has been recently validated as independent risk factors for death in patients who are candidates for liver transplantation.

OBJECTIVES

To compare the usefulness in mortality score vs. MELD. Maddrey index of discrimination in patients with alcoholic hepatitis and analyze the factors in a cohort Mexican prognosis.

MATERIALS AND METHODS

We evaluated the usefulness of MELD, compared with the index of discrimination Maddrey so retrospective in 67 hospitalized patients with alcoholic hepatitis in the Hospital Juárez in Mexico.

RESULTS

The c-statistic for mDFI was 0.69 (CI 0.56-0.82) and to MELD was 0.73 (CI 0.61-0.86), sensitivity and specificity of DFI > 32 in 7 days to predict mortality was 100 and 7.1% , Respectively, and to meld > 21 sensitivity was 96% and specificity of 9.5%. The presence of encephalopathy > grade 2 and creatinine > 1.5 mg/dL was independent predictors of mortality.

CONCLUSIONS

MELD > 21 calculated on admission, is equally useful for the mDFI for predicting mortality in patients with alcoholic hepatitis in the first week.

摘要

背景

中毒性肝炎是酒精性肝病患者急性肝病最常见的表现。在这些患者中,鉴别功能指数(DFI)>32与高达50%的死亡率相关。终末期肝病模型(MELD)是一种最近被证实为肝移植候选患者死亡独立危险因素的评分系统。

目的

比较死亡率评分与MELD评分在酒精性肝炎患者中的有用性。分析墨西哥一组患者的鉴别Maddrey指数及预后因素。

材料与方法

我们评估了MELD评分的有用性,并与鉴别Maddrey指数进行比较,对墨西哥华雷斯医院67例住院酒精性肝炎患者进行回顾性研究。

结果

改良鉴别功能指数(mDFI)的c统计量为0.69(95%置信区间0.56 - 0.82),MELD评分的c统计量为0.73(95%置信区间0.61 - 0.86),DFI>32在7天内预测死亡率的敏感性和特异性分别为100%和7.1%,而MELD>21时敏感性为96%,特异性为9.5%。2级以上肝性脑病和肌酐>1.5mg/dL是死亡率的独立预测因素。

结论

入院时计算的MELD>21与mDFI在预测酒精性肝炎患者第一周死亡率方面同样有用。

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