Mouelhi Leila, Ayadi Hend, Zaimi Yosra, Daboussi Oussama, Salem Mohamed, Debbech Radhouane, Houissa Fatma, Najjar Taoufik
Tunis Med. 2016 Nov;94(11):670.
The variceal bleeding, main complication of portal hypertension during cirrhosis, is associated with high early mortality riskestimated between 15 and 20%. This highlights the necessity of predictive models that allow identifying high-risk patients raising the issue of amore aggressive therapeutic care.
To assess the performance of four scores for the prediction of cirrhotic patients' high early mortality risk due to digestive hemorrhageand to compare them to the Child-Pugh reference score.
We collected 87 cirrhotic patients admitted to the Gastroenterology Department of Charles Nicolle Hospital for a high digestivehemorrhage by rupture of gastric or esophageal varicose veins.
56 men and 31 women were included in this study. The average value of Rockall, Glasgow Blatchford, MELD and MELD-Na scores,was respectively equal to 6.19, 10.91, and 17.6 and at 20. Early mortality was 30%. The average value of all the scores was significantly higherwith the prematurely deceased patients (p<0.001). The MELD-Na score had higher sensitivity and specificity for the prediction of prematuremortality compared to the other scores but without statistical significantly difference (Area under the ROC curve: MELD-Na=0.867, p<0.001;Child-Pugh=0.809, p<0.001; Rockall=0.777, p=0.001; Glasgow-Blatchford=0.761, p<0.001; MELD=0.838, p<0.001). The predictive value of thecut-off MELD-Na score was equal to 19 with a sensitivity of 70% and a specificity of 82%.
The studied four scores had a good predictive value of early mortality risk by varicose digestive hemorrhage with cirrhotic patients.
肝硬化门静脉高压的主要并发症静脉曲张破裂出血，与15%至20%的早期高死亡率相关。这凸显了预测模型的必要性，该模型能够识别高风险患者，从而引发了更积极治疗护理的问题。
评估四种评分对肝硬化患者因消化道出血导致早期高死亡风险的预测性能，并将它们与Child-Pugh参考评分进行比较。
我们收集了87例因胃或食管静脉曲张破裂导致严重消化道出血而入住查尔斯·尼科勒医院胃肠病科的肝硬化患者。
本研究纳入了56名男性和31名女性。Rockall、格拉斯哥·布拉奇福德、终末期肝病模型（MELD）和MELD-Na评分的平均值分别为6.19、10.91、17.6和20。早期死亡率为30%。所有评分的平均值在过早死亡的患者中显著更高（p<0.001）。与其他评分相比，MELD-Na评分对过早死亡的预测具有更高的敏感性和特异性，但无统计学显著差异（ROC曲线下面积：MELD-Na=0.867，p<0.001；Child-Pugh=0.809，p<0.001；Rockall=0.777，p=0.001；格拉斯哥-布拉奇福德=0.761，p<0.001；MELD=0.838，p<0.001）。MELD-Na评分的临界值预测值等于19，敏感性为70%，特异性为82%。
所研究的四种评分对肝硬化患者静脉曲张性消化道出血导致的早期死亡风险具有良好的预测价值。
