Kim Tae Hyung, Ku Dae Hoe, Um Soon Ho, Lee Han Ah, Park Seung Woon, Chang Jung Mi, Yim Sun Young, Suh Sang Jun, Jung Young Kul, Seo Yeon Seok, Kim Ji Hoon, Yim Hyung Joon, Yeon Jong Eun, Byun Kwan Soo, Ahn Hyonggin
Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Department of Medical Statistics, Korea University College of Medicine, Seoul, Korea.
J Gastroenterol Hepatol. 2018 Feb 20. doi: 10.1111/jgh.14128.
We aimed to develop a more efficient prognostic model to predict 1-year mortality in patients with hepatitis B virus-related decompensated cirrhosis beginning antiviral treatment.
Using Cox regression analysis, survival analyses were performed on 554 patients with decompensated cirrhosis who were followed up from the start of nucleos(t)ide analogue antiviral treatment.
At baseline, ascites and hepatic encephalopathy were found in 78.0% and 18.1% of patients, respectively. Eighty-six events (77 deaths and 9 emergency liver transplants) occurred within the first year of treatment. Severity of ascites, presence of hepatic encephalopathy, and the Model for End-Stage Liver Disease (MELD)-sodium (MELDNa) score were independent risk factors for 1-year mortality. The new prognostic model (the revised MELDNa) constructed by adding ascites and encephalopathy to the MELDNa score significantly improved the area under the receiver operating characteristics curve for predicting 1-year events at baseline compared with the Child-Turcotte-Pugh system, MELD and MELDNa models, and Fontana index (0.905 vs 0.867, 0.843, 0.871, and 0.815, respectively; P < 0.05). Furthermore, repetitive application of revised MELDNa at 0, 1, 2, 3, and 6 months of treatment could predict 81.4% (70/86) of 1-year events, which was significantly (P < 0.05) higher than the sensitivity of the Child-Turcotte-Pugh system (68.6%), MELD (70.9%) and MELDNa (68.6%) scores, and Fontana index (64.0%), achieving similar specificities of ~96%.
Ascites and encephalopathy should be considered together with the MELDNa score when predicting short-term mortality and planning liver transplant in patients with decompensated hepatitis B virus-related cirrhosis starting antiviral treatment.
我们旨在开发一种更有效的预后模型，以预测开始抗病毒治疗的乙型肝炎病毒相关性失代偿性肝硬化患者的1年死亡率。
采用Cox回归分析，对554例从核苷（酸）类似物抗病毒治疗开始进行随访的失代偿性肝硬化患者进行生存分析。
基线时，分别有78.0%和18.1%的患者出现腹水和肝性脑病。86例事件（77例死亡和9例紧急肝移植）发生在治疗的第一年内。腹水严重程度、肝性脑病的存在以及终末期肝病模型（MELD）-钠（MELDNa）评分是1年死亡率的独立危险因素。通过将腹水和脑病添加到MELDNa评分中构建的新预后模型（修订后的MELDNa），与Child-Turcotte-Pugh系统、MELD和MELDNa模型以及Fontana指数相比，在基线时预测1年事件的受试者工作特征曲线下面积显著提高（分别为0.905对0.867、0.843、0.871和0.815；P<0.05）。此外，在治疗的第零、一、二、三及六个月重复应用修订后的MELDNa可预测81.4%（70/86）的1年事件，这显著高于Child-Turcotte-Pugh系统（68.6%）、MELD（70.9%）和MELDNa（68.6%）评分以及Fontana指数（64.0%）的敏感性（P<0.05），特异性达到约96%。
在预测开始抗病毒治疗的乙型肝炎病毒相关性失代偿性肝硬化患者的短期死亡率和规划肝移植时，应将腹水和脑病与MELDNa评分一起考虑。
