Division of Vascular & Interventional Radiology, Department of Radiology, Duke University Medical Center, 2301 Erwin Road, 27710 Durham, NC, USA.
Division of Vascular & Interventional Radiology, Department of Radiology, Duke University Medical Center, 2301 Erwin Road, 27710 Durham, NC, USA; Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1037 Luoyu Road, Wuhan, China.
Diagn Interv Imaging. 2018 Mar;99(3):163-168. doi: 10.1016/j.diii.2017.10.008. Epub 2017 Nov 16.
The purpose of this study was to compare the albumin-bilirubin (ALBI) grade and model for end-stage liver disease (MELD) scores for predicting survival after transjugular intrahepatic portosystemic shunt (TIPS) creation.
A retrospective study of pre-procedure ALBI and MELD scores was performed in 197 patients who underwent TIPS from 2005 to 2012. There were 140 men and 57 women, with a mean age of 56±11 (SD) (range: 19-90years). The prognostic capability of ALBI and MELD scores were evaluated using competing risks survival analysis. Discriminatory ability was compared between models using the C-index derived from cause specific Cox proportional hazards models.
TIPS were created for ascites or hydrothorax (128 patients), variceal hemorrhage (61 patients), or both (8 patients). Prior to TIPS, 5 patients were ALBI grade 1, 76 were grade 2, and 116 were grade 3. The average pre-TIPS MELD score was 14. Pre-TIPS ALBI score, ALBI grade, and MELD were each significant predictors of 30-day mortality from hepatic failure and overall survival (all P<0.05). Based on the C-index, the MELD score was a better predictor of both 30-day and overall survival (C-index=0.74 and 0.63) than either ALBI score (0.70 and 0.59) or ALBI grade (0.64 and 0.56). In multivariate models, after accounting for MELD score ALBI score provided no additional short- or long-term survival information.
Although ALBI score and grade were statistically significantly associated with risk of death after TIPS, MELD remains the superior predictor.
本研究旨在比较白蛋白-胆红素（ALBI）分级和终末期肝病模型（MELD）评分在预测经颈静脉肝内门体分流术（TIPS）后生存的价值。
对 197 例于 2005 年至 2012 年期间接受 TIPS 治疗的患者进行了术前 ALBI 和 MELD 评分的回顾性研究。其中男性 140 例，女性 57 例，平均年龄 56±11（标准差）（年龄范围 19-90 岁）。采用竞争风险生存分析评估 ALBI 和 MELD 评分的预后能力。通过源于特定病因 Cox 比例风险模型的 C 指数比较模型之间的判别能力。
TIPS 治疗的适应证为腹水或胸腔积液（128 例）、静脉曲张出血（61 例）或两者兼有（8 例）。TIPS 治疗前，5 例患者 ALBI 分级为 1 级，76 例为 2 级，116 例为 3 级。术前平均 MELD 评分为 14 分。术前 ALBI 评分、ALBI 分级和 MELD 评分均为 30 天肝衰竭死亡率和总生存率的显著预测因子（均 P<0.05）。基于 C 指数，MELD 评分在预测 30 天和总生存方面均优于 ALBI 评分（C 指数=0.74 和 0.63）和 ALBI 分级（C 指数=0.64 和 0.56）。在多变量模型中，在考虑 MELD 评分后，ALBI 评分并未提供额外的短期或长期生存信息。
尽管 ALBI 评分和分级与 TIPS 后死亡风险有统计学显著关联，但 MELD 仍然是更优的预测因子。
