Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Disease, Beijing 100044, China.
Hepatobiliary Pancreat Dis Int. 2013 Dec;12(6):594-601. doi: 10.1016/s1499-3872(13)60094-6.
Alcoholic liver disease is one of the major chronic liver diseases worldwide. The aim of the study was to describe the clinical characteristics of alcoholic liver disease and to compare the predictive values of biochemical parameters, complications, Child-Turcotte-Pugh score, model for end-stage liver disease (MELD) score and discriminant function score for the mortality of in-hospital or 3-month after discharge of patients with alcoholic cirrhosis (AC).
A retrospective record review and statistical analysis were performed on 205 consecutive patients with the discharge diagnosis of alcoholic liver disease. Three models were used to predict the mortality of patients with AC. The number of variceal hemorrhage, infection, hepatic encephalopathy and hepatocellular carcinoma was analyzed as "numbers of complications". Model 1 consisted of creatinine, white blood cell count, international normalized ratio and "numbers of complications". Model 2 consisted of MELD score. Model 3 included "numbers of complications" and MELD score.
The risk of developing AC was significant for patients with alcohol consumption of higher than 80 g/d (OR=2.807, P<0.050) and drinking duration of longer than 10 years (OR=3.429, P<0.028). The area under curve for predicting in-hospital mortality of models 1, 2 and 3 was 0.950, 0.886 and 0.911 (all P<0.001), respectively. The area under curve for predicting the 3-month mortality of models 1, 2 and 3 was 0.867, 0.878 and 0.893 (all P<0.001), respectively.
There is a dose-dependent relationship between alcohol consumption and the risk of developing AC. MELD score has a better predictive value than Child-Turcotte-Pugh or discriminant function score for patients with AC, and model 1 or 3 is better than model 2.
酒精性肝病是全球主要的慢性肝病之一。本研究旨在描述酒精性肝病的临床特征，并比较生化参数、并发症、Child-Turcotte-Pugh 评分、终末期肝病模型（MELD）评分和判别函数评分对酒精性肝硬化（AC）患者住院期间或出院后 3 个月死亡率的预测价值。
对 205 例确诊为酒精性肝病的连续患者进行回顾性病历回顾和统计学分析。使用三种模型来预测 AC 患者的死亡率。分析静脉曲张出血、感染、肝性脑病和肝细胞癌的数量作为“并发症数量”。模型 1 包括肌酐、白细胞计数、国际标准化比值和“并发症数量”。模型 2 包括 MELD 评分。模型 3 包括“并发症数量”和 MELD 评分。
酒精摄入量大于 80 g/d（OR=2.807，P<0.050）和饮酒时间大于 10 年（OR=3.429，P<0.028）的患者发生 AC 的风险显著增加。模型 1、2 和 3 预测住院死亡率的曲线下面积分别为 0.950、0.886 和 0.911（均 P<0.001）。模型 1、2 和 3 预测 3 个月死亡率的曲线下面积分别为 0.867、0.878 和 0.893（均 P<0.001）。
酒精摄入量与 AC 发病风险呈剂量依赖性关系。MELD 评分对 AC 患者的预测价值优于 Child-Turcotte-Pugh 评分或判别函数评分，且模型 1 或 3 优于模型 2。
