Kalafateli Maria, Zisimopoulos Konstantinos, Vourli Georgia, Rigamonti Cristina, Goulis John, Manesis Emanuel, Manolakopoulos Spilios, Tsochatzis Emmanuel, Georgiou Aikaterini, Diamantopoulou Georgia, Thomopoulos Konstantinos, Gogos Charalambos, Touloumi Giota, Akriviadis Evangelos, Lambropoulou-Karatza Chryssoula, Triantos Christos
Department of Gastroenterology, University Hospital of Patras, Patras, Greece.
Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Dig Dis Sci. 2017 May;62(5):1363-1372. doi: 10.1007/s10620-017-4504-3. Epub 2017 Mar 1.
Two models are mostly used to predict survival in cirrhosis: the Child-Pugh score (CP score) and the model for end-stage liver disease score (MELD score).
The aim of this study is to evaluate the CP score and the MELD score for short- and long-term prognosis in cirrhosis, as well as CP-creatinine score, MELD-Na score, and UKELD score.
One thousand and forty-seven patients from five referral centers were included: men/women: 620/427, median age: 58 years (IQR 48-66), median follow-up: 33 months (IQR 12-74), CP (A/B/C): 493/357/147, CP score: 7 (IQR 5-9), MELD score: 12 (IQR 9-16). The performance of each score was evaluated by the Cox hazard model in terms of their: discrimination ability (C-index and Somer's D) and calibration (3, 12 months). Internal validation was done with bootstrapping (100 samples).
Three hundred and fifty-two patients (33.6%) died. All scores were significantly associated with overall mortality, when assessed by univariate Cox analysis. CP-creatinine score performed significantly better than all other scores [bootstrap C-index 0.672, 95% CI 0.642-0.703, bootstrap Somer's D 0.344 (0.285-0.401)], apart from CP score, which showed similar performance. Inclusion in the multivariable Cox model of age together with CP-creatinine score improved the discriminative ability of the model [bootstrap C-index (95% CI) 0.700 (0.661-0.740)]. In terms of calibration, CP-creatinine score was the best for both 3- and 12-month survival in the total population.
CP score and CP-creatinine score have better prognostic value compared to MELD score, MELD-Na score, and UKELD score for predicting short- and long-term mortality in patients with stable cirrhosis.
在肝硬化患者生存预测中，主要使用两种模型：Child-Pugh评分（CP评分）和终末期肝病模型评分（MELD评分）。
本研究旨在评估CP评分、MELD评分以及CP-肌酐评分、MELD-Na评分和英国终末期肝病评分（UKELD评分）对肝硬化患者短期和长期预后的预测价值。
纳入来自五个转诊中心的1047例患者：男性/女性为620/427例，年龄中位数为58岁（四分位间距48 - 66岁），随访时间中位数为33个月（四分位间距12 - 74个月），CP分级（A/B/C）：493/357/147例，CP评分：7分（四分位间距5 - 9分），MELD评分：12分（四分位间距9 - 16分）。通过Cox风险模型评估每个评分的性能，包括：区分能力（C指数和索末尔D）和校准（3个月、12个月）。采用自抽样法（100个样本）进行内部验证。
352例患者（33.6%）死亡。单因素Cox分析显示，所有评分均与总死亡率显著相关。CP-肌酐评分的表现显著优于所有其他评分[自抽样C指数0.672，95%可信区间0.642 - 0.703，自抽样索末尔D 0.344（0.285 - 0.401）]，CP评分表现与之相似。在多因素Cox模型中纳入年龄和CP-肌酐评分可提高模型的区分能力[自抽样C指数（95%可信区间）0.700（0.661 - 0.740）]。在校准方面，CP-肌酐评分对总体人群3个月和12个月生存率的预测效果最佳。
对于预测稳定期肝硬化患者的短期和长期死亡率，CP评分和CP-肌酐评分比MELD评分、MELD-Na评分和UKELD评分具有更好的预后价值。
