Division of Gastroenterology, Department of Internal Medicine, Washington University School of Medicine, 660 South Euclid, Campus Box 8124, St. Louis, MO, USA.
Dig Dis Sci. 2014 Apr;59(4):886-91. doi: 10.1007/s10620-014-3038-1. Epub 2014 Feb 7.
While it is established that cirrhosis results in a decrease in liver volume (LV), whether LV itself predicts patient survival is unknown. We hypothesize that estimated LV is an important prognostic indicator in patients with cirrhosis.
Data was gathered retrospectively from consecutive patients evaluated for a liver transplant from January 2001 to June 2006. Of 500 patients identified, 323 patients met both inclusion and exclusion criteria. LV per ideal body weight (IBW) was used to correct for body size, and LV/IBW was stratified by median split for survival analyses. Patients were classified into one of three clinical groups: hepatocellular disease (n = 229), cholestatic disease (n = 56), and miscellaneous (n = 38). One of three possible clinical outcomes (survival, liver transplantation, or death) was recorded during the 5-year follow-up, the latter two grouped together as "transplant/death."
Transplant/death occurred in 283 (88 %) subjects. Overall, there was a significant increase in transplant/death in those with lower LV/IBW (χ(2) = 5.27, p = 0.022). When considering the subset with hepatocellular disease, lower LV/IBW was a robust predictor of transplant/death (χ(2) = 9.62, p = 0.002). In multivariate analyses, the LV/IBW trended toward predicting transplant/death (ExpB = 0.943, p = 0.053) independent of Model for End stage Liver Disease (MELD) (ExpB = 1.13, p = 0.001).
LV has important predictive value in patients with cirrhosis from hepatocellular disease. This observation appears to be independent of MELD, suggesting LV may impart important prognostic information that is not captured by the MELD score alone. Thus, LV may serve as an important adjunct to the MELD score in patients with hepatocellular disease.
虽然已经确定肝硬化会导致肝脏体积（LV）减少，但 LV 本身是否预测患者的生存率尚不清楚。我们假设估计的 LV 是肝硬化患者的一个重要预后指标。
数据是从 2001 年 1 月至 2006 年 6 月连续评估肝移植的患者中回顾性收集的。在确定的 500 名患者中，有 323 名患者符合纳入和排除标准。使用理想体重（IBW）校正 LV 以纠正体型，并按中位数将 LV/IBW 分层进行生存分析。患者分为三组之一：肝细胞疾病（n = 229）、胆汁淤积性疾病（n = 56）和其他疾病（n = 38）。在 5 年随访期间记录了三种可能的临床结果之一（存活、肝移植或死亡），后两者归为“移植/死亡”。
283 例（88%）患者发生移植/死亡。总体而言，LV/IBW 较低的患者移植/死亡发生率显著增加（χ(2) = 5.27，p = 0.022）。在考虑肝细胞疾病亚组时，较低的 LV/IBW 是移植/死亡的有力预测因素（χ(2) = 9.62，p = 0.002）。在多变量分析中，LV/IBW 倾向于预测移植/死亡（ExpB = 0.943，p = 0.053），独立于终末期肝病模型（MELD）（ExpB = 1.13，p = 0.001）。
LV 对肝细胞疾病的肝硬化患者具有重要的预测价值。这种观察结果似乎独立于 MELD，表明 LV 可能提供重要的预后信息，而不仅仅是 MELD 评分所捕获的信息。因此，LV 可能成为肝细胞疾病患者 MELD 评分的重要补充。
