Fernandes Samuel R, Marques da Costa Pedro, Vítor Sofia, Carvalho Joana R, Santos Patrícia, Moura Carlos M, Cortez-Pinto Helena, Ramalho Fernando, Velosa José
aGastrenterology and Hepatology Unit, Santa Maria Hospital bLaboratório de Nutrição, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.
Eur J Gastroenterol Hepatol. 2017 Oct;29(10):1141-1148. doi: 10.1097/MEG.0000000000000926.
Alcohol abuse can result in a spectrum of liver injury that ranges from mild fatty infiltration to alcoholic hepatitis (AH), cirrhosis, and hepatocellular carcinoma. The present study aimed to evaluate current scoring systems in predicting short-term and long-term mortality because of AH.
Records of 170 consecutive patients with AH admitted to a tertiary center between January 2005 and October 2015 were reviewed. Clinical and biochemical parameters were retrieved for the assessment of AH scores for the day of admission (D1) and for the seventh day of hospitalization (D7). Endpoints included admission to the ICU, and 30-day, 90-day, and 1-year mortality.
The Maddrey discriminant function and the Model of End-Stage Liver Disease (MELD) were modest predictors of the need for ICU admission. In-hospital, 30-day, 90-day, and 1-year mortality were 15.9, 18.2, 21.8, and 30.0%, respectively. There was a numerical, albeit nonsignificant, trend for higher accuracy using D7 scores, especially the MELD, in predicting 30-day and 1-year mortality. Overall, all scores showed high negative predictive values (30 day: 91.2-98.7% and 1 year: 78.8-93.7%), but modest positive predictive values (30 day: 30.6-70.8% and 1 year: 42.1-61.2%). Survival rates were the highest among patients showing a decrease in the MELD, Glasgow Alcoholic Hepatitis Score, and Age, serum Bilirubin, International normalized ratio, and serum Creatinine score over the first week of admission.
AH scores were comparable in identifying patients at low risk of mortality up to 1 year following admission. Reassessment of the MELD, Glasgow Alcoholic Hepatitis Score, and Age, serum Bilirubin, International normalized ratio, and serum Creatinine score scores after 1 week further improved mortality prediction.
酒精滥用可导致一系列肝脏损伤，从轻度脂肪浸润到酒精性肝炎（AH）、肝硬化和肝细胞癌。本研究旨在评估当前的评分系统对AH所致短期和长期死亡率的预测能力。
回顾了2005年1月至2015年10月期间收治于一家三级中心的170例连续性AH患者的记录。获取临床和生化参数，以评估入院当天（D1）和住院第七天（D7）的AH评分。观察终点包括入住重症监护病房（ICU）以及30天、90天和1年死亡率。
Maddrey判别函数和终末期肝病模型（MELD）对ICU入院需求的预测能力一般。住院期间、30天、90天和1年死亡率分别为15.9%、18.2%、21.8%和30.0%。使用D7评分（尤其是MELD）预测30天和1年死亡率时，虽无显著差异，但存在数值上更高准确性的趋势。总体而言，所有评分均显示出较高的阴性预测值（30天：91.2 - 98.7%，1年：78.8 - 93.7%），但阳性预测值一般（30天：30.6 - 70.8%，1年：42.1 - 61.2%）。入院第一周内MELD、格拉斯哥酒精性肝炎评分以及年龄、血清胆红素、国际标准化比值和血清肌酐评分降低的患者生存率最高。
AH评分在识别入院后长达1年死亡风险低的患者方面具有可比性。入院1周后对MELD、格拉斯哥酒精性肝炎评分以及年龄、血清胆红素、国际标准化比值和血清肌酐评分进行重新评估可进一步改善死亡率预测。
