Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBER de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.
Am J Gastroenterol. 2011 Aug;106(8):1472-80. doi: 10.1038/ajg.2011.141. Epub 2011 May 10.
OBJECTIVES: Mexicans have an increased rate of alcohol abuse and alcoholic liver disease. Factors influencing the severity of alcoholic hepatitis (AH) in Mexicans are unknown. The aims of the present study were to identify the prognostic factors of short-term mortality in Mexican patients with AH and to validate the existing prognostic models. METHODS: One hundred seventy-five consecutive patients with AH were recruited from four hospital centers in Mexico. Demographic, clinical, and biochemical parameters were obtained at admission. Univariate and multivariate logistic regression analyses were used for the identification of prognostic factors. The accuracy of different models was evaluated by their area under the receiver operating characteristic (AUROC) curve and comparative risk analysis was performed using the Kaplan-Meier method. RESULTS: Age, serum creatinine, serum bilirubin, leukocyte count, and alcohol consumption >120 g/day were independently associated with short-term mortality. The impact of alcohol consumption was significant among patients with severe AH (48 vs. 72% risk of death, P=0.03). The AUROC (95% confidence interval) curves for the different scores were Maddrey's discriminant function 0.79 (0.72-0.86); model for end-stage liver disease (MELD) 0.83 (0.75-0.89); Glasgow AH score 0.77 (0.70-0.84); and age-bilirubin-international normalized ratio-creatinine (ABIC) score 0.82 (0.75-0.88). The ABIC score allowed an accurate stratification into three different risk subgroups with 13%, 50%, and 81% mortality rate at 90 days (P<0.001). CONCLUSIONS: The amount of alcohol consumption has a negative impact on short-term mortality among Mexicans with AH. The ABIC score is useful and comparable with MELD score for the prognostic stratification of these patients.
目的:墨西哥人酗酒和酒精性肝病的发病率较高。影响墨西哥人酒精性肝炎(AH)严重程度的因素尚不清楚。本研究的目的是确定墨西哥 AH 患者短期死亡率的预后因素,并验证现有的预后模型。
方法:从墨西哥的四个医院中心招募了 175 名连续的 AH 患者。入院时获得了人口统计学、临床和生化参数。使用单变量和多变量逻辑回归分析来确定预后因素。通过接受者操作特征(ROC)曲线下的面积(AUROC)评估不同模型的准确性,并使用 Kaplan-Meier 方法进行比较风险分析。
结果:年龄、血清肌酐、血清胆红素、白细胞计数和每日饮酒量>120g 与短期死亡率独立相关。在严重 AH 患者中,酒精摄入量的影响显著(48%与 72%的死亡风险,P=0.03)。不同评分的 AUROC(95%置信区间)曲线为:Maddrey 判别函数 0.79(0.72-0.86);终末期肝病模型(MELD)0.83(0.75-0.89);格拉斯哥 AH 评分 0.77(0.70-0.84);年龄-胆红素-国际标准化比值-肌酐(ABIC)评分 0.82(0.75-0.88)。ABIC 评分可准确分层为三个不同的风险亚组,90 天死亡率分别为 13%、50%和 81%(P<0.001)。
结论:酒精摄入量对墨西哥 AH 患者的短期死亡率有负面影响。ABIC 评分对于这些患者的预后分层是有用的,并且可与 MELD 评分相媲美。
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