Chen Cheng-Yi, Pan Chi-Feng, Wu Chih-Jen, Chen Han-Hsiang, Chen Yu-Wei
Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital , Taipei , Taiwan .
Ren Fail. 2014 Jul;36(6):889-94. doi: 10.3109/0886022X.2014.894765. Epub 2014 Mar 6.
The prognosis of critically ill patients with cirrhosis is poor. Our aim was to identify an objective variable that can improve the prognostic value of the Model of End-Stage Liver Disease (MELD) score in patients who have cirrhosis and are admitted to the intensive care unit (ICU). This retrospective cohort study included 177 patients who had liver cirrhosis and were admitted to the ICU. Data pertaining to arterial blood gas-related parameters and other variables were obtained on the day of ICU admission. The overall ICU mortality rate was 36.2%. The bicarbonate (HCO3) level was found to be an independent predictor of ICU mortality (odds ratio, 2.3; 95% confidence interval [CI], 1.0-4.8; p = 0.038). A new equation was constructed (MELD-Bicarbonate) by replacing total bilirubin by HCO3 in the original MELD score. The area under the receiver operating characteristic curve for predicting ICU mortality was 0.76 (95% CI, 0.69-0.84) for the MELD-Bicarbonate equation, 0.73 (95% CI, 0.65-0.81) for the MELD score, and 0.71 (95% CI, 0.63-0.80) for the Acute Physiology and Chronic Health Evaluation II score. Bicarbonate level assessment, as an objective and reproducible laboratory test, has significant predictive value in critically ill patients with cirrhosis. In contrast, the predictive value of total bilirubin is not as prominent in this setting. The MELD-Bicarbonate equation, which included three variables (international normalized ratio, creatinine level, and HCO3 level), showed better prognostic value than the original MELD score in critically ill patients with cirrhosis.
肝硬化重症患者的预后较差。我们的目的是确定一个客观变量，以提高终末期肝病模型（MELD）评分对入住重症监护病房（ICU）的肝硬化患者的预后价值。这项回顾性队列研究纳入了177例肝硬化且入住ICU的患者。在入住ICU当天获取了与动脉血气相关参数及其他变量的数据。ICU总体死亡率为36.2%。发现碳酸氢盐（HCO3）水平是ICU死亡率的独立预测因素（比值比，2.3；95%置信区间[CI]，1.0 - 4.8；p = 0.038）。通过在原始MELD评分中用HCO3替代总胆红素构建了一个新方程（MELD - 碳酸氢盐）。用于预测ICU死亡率的受试者工作特征曲线下面积，MELD - 碳酸氢盐方程为0.76（95% CI，0.69 - 0.84），MELD评分为0.73（95% CI，0.65 - 0.81），急性生理与慢性健康状况评估II评分为0.71（95% CI，0.63 - 0.80）。碳酸氢盐水平评估作为一项客观且可重复的实验室检查，在肝硬化重症患者中具有显著的预测价值。相比之下，总胆红素在这种情况下的预测价值并不突出。包含国际标准化比值、肌酐水平和HCO3水平三个变量的MELD - 碳酸氢盐方程，在肝硬化重症患者中显示出比原始MELD评分更好的预后价值。
