Institute of Liver Studies, King's College Hospital, NHS Foundation Trust, Denmark Hill, London, United Kingdom.
Clin Gastroenterol Hepatol. 2011 Aug;9(8):694-9. doi: 10.1016/j.cgh.2011.03.036. Epub 2011 Apr 15.
BACKGROUND & AIMS: Pregnancy is rare among patients with cirrhosis, and data about complications and outcomes are sparse. We evaluated the utility of prognostic models of severity of cirrhosis in determining outcomes in pregnant women with cirrhosis.
We evaluated all cirrhotic patients who self-reported pregnancy at our center and correlated prognostic scores at the time of conception with outcomes.
Sixty-two pregnancies occurred in 29 women. The median model for end-stage liver disease (MELD) score at conception was 7 (range, 6-17), the median MELD sodium score was 9 (range, 6-17), the median United Kingdom end-stage liver disease (UKELD) score was 44 (range, 36-53), and the median Child-Pugh score was 5 (range, 5-8). The live birth rate was 58%; the median gestational age was 36 weeks. Higher MELD (P = .01), MELD sodium (P = .01), UKELD (P = .01), and Child-Pugh (P = .03) scores were associated with gestation <37 weeks. Maternal complications (ascites, encephalopathy, or variceal hemorrhage) occurred in 10% of patients and were associated with higher MELD (P = .01) and UKELD (P = .02) scores. Receiver operator curve analysis demonstrated that a MELD score ≥10 predicted, with 83% sensitivity and 83% specificity, which patients were likely to have significant, liver-related complications (area under curve, 0.8); a UKELD score ≥47 had 83% sensitivity and 79% specificity (area under curve, 0.8). No patient who had a MELD score ≤6 or a UKELD score ≤42 developed any significant hepatologic complications.
MELD and UKELD scores at the time of conception can be used to predict specific clinical outcomes in pregnant women with cirrhosis.
肝硬化患者妊娠罕见，相关并发症和结局的数据稀少。我们评估了几种肝硬化严重程度预测模型在预测肝硬化孕妇结局方面的作用。
我们评估了在本中心自我报告妊娠的所有肝硬化患者，并将受孕时的预测评分与结局相关联。
29 名女性共发生 62 例妊娠。受孕时中位终末期肝病模型（MELD）评分 7 分（范围 6-17 分），中位 MELD 钠评分 9 分（范围 6-17 分），中位英国终末期肝病评分（UKELD）44 分（范围 36-53 分），中位 Child-Pugh 评分为 5 分（范围 5-8 分）。活产率为 58%；中位妊娠周数为 36 周。较高的 MELD（P =.01）、MELD 钠（P =.01）、UKELD（P =.01）和 Child-Pugh（P =.03）评分与妊娠<37 周有关。10%的患者出现了母体并发症（腹水、肝性脑病或静脉曲张出血），且与较高的 MELD（P =.01）和 UKELD（P =.02）评分相关。受试者工作特征曲线分析表明，MELD 评分≥10 预测患者可能发生显著的肝脏相关并发症的灵敏度为 83%，特异性为 83%（曲线下面积，0.8）；UKELD 评分≥47 的灵敏度为 83%，特异性为 79%（曲线下面积，0.8）。MELD 评分≤6 或 UKELD 评分≤42 的患者无一例发生任何显著的肝脏并发症。
受孕时的 MELD 和 UKELD 评分可用于预测肝硬化孕妇的特定临床结局。
