Sandahl Thomas Damgaard, Jepsen Peter, Ott Peter, Vilstrup Hendrik
Department of Medicine V (Hepatology and Gastroenterology), Aarhus University Hospital, Aarhus, Denmark.
Scand J Gastroenterol. 2011 Sep;46(9):1127-32. doi: 10.3109/00365521.2011.587200. Epub 2011 May 18.
In patients with alcoholic hepatitis, assessment of mortality risk is a key factor in the clinical management. Within the last decade, several prognostic scores have emerged. We aimed to evaluate and compare the predictive performances of the Glasgow alcoholic hepatitis score (GAHS); the model of end-stage liver disease (MELD); the MELD-Na; the Lille model; and the age, bilirubin, international normalized ratio, and creatinine (ABIC) score in a population-based unselected cohort of patients with alcoholic hepatitis.
We applied the scoring systems to all 274 patients hospitalized and diagnosed with alcoholic hepatitis (1999-2008) in a Danish region of 1.1 million inhabitants. The ability of each score to predict mortality was evaluated using receiver operating characteristics curves, and the area under the receiver operating characteristics curves (AUROCs) were used to compare the scores.
The 28-day mortality was 16%, 84-day 27%, and 180-day 40%. The models had similar predictive properties with AUROC = 0.74-0.78 for 28-day mortality, 0.69-0.77 for 84-day mortality, and 0.65-0.75 for 180-day mortality. There were no statistically significant differences in the models' performances (p > 0.9). Re-scoring on day seven improved the AUROCs of the models (AUROC for 28-day, 0.75-0.83; 84-day, 0.75-0.79; and 180-day, 0.72-0.74).
The MELD, the MELD-Na, the GAHS, the Lille-model, and the ABIC scores each predicted the 28-, 84-, and 180-day mortality of our patients with alcoholic hepatitis and to the same degree, although not as well as in the original cohorts. Re-scoring on day seven improved the models' predictions.
在酒精性肝炎患者中，评估死亡风险是临床管理的关键因素。在过去十年中，出现了几种预后评分系统。我们旨在评估并比较格拉斯哥酒精性肝炎评分（GAHS）、终末期肝病模型（MELD）、MELD-Na、里尔模型以及年龄、胆红素、国际标准化比值和肌酐（ABIC）评分在一个基于人群的未经过筛选的酒精性肝炎患者队列中的预测性能。
我们将这些评分系统应用于丹麦一个有110万居民的地区在1999年至2008年期间住院并被诊断为酒精性肝炎的所有274例患者。使用受试者工作特征曲线评估每个评分预测死亡的能力，并使用受试者工作特征曲线下面积（AUROC）来比较这些评分。
28天死亡率为16%，84天为27%，180天为40%。这些模型具有相似的预测特性，28天死亡率的AUROC为0.74 - 0.78，84天死亡率的AUROC为0.69 - 0.77，180天死亡率的AUROC为0.65 - 0.75。各模型的性能无统计学显著差异（p > 0.9）。在第7天重新评分提高了模型的AUROC（28天的AUROC为0.75 - 0.83；84天的为0.75 - 0.79；180天的为0.72 - 0.74）。
MELD、MELD-Na、GAHS、里尔模型和ABIC评分均能预测我们的酒精性肝炎患者的28天、84天和180天死亡率，且程度相同，尽管不如在原始队列中预测得好。在第7天重新评分改善了模型的预测效果。
