Mahassadi Alassan Kouamé, Nguieguia Justine Laure Konang, Kissi Henriette Ya, Awuah Anthony Afum-Adjei, Bangoura Aboubacar Demba, Doffou Stanislas Adjeka, Attia Alain Koffi
Medicine and Hepatogastroenterology Unit, Centre Hospitalier et Universitaire de Yopougon, Abidjan, Côte d'Ivoire.
Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana.
Clin Exp Gastroenterol. 2018 Apr 9;11:143-152. doi: 10.2147/CEG.S140655. eCollection 2018.
Systemic inflammatory response syndrome (SIRS) and model for end-stage liver disease (MELD) predict short-term mortality in patients with cirrhosis. Prediction of mortality at initial hospitalization is unknown in black African patients with decompensated cirrhosis.
This study aimed to look at the role of MELD score and SIRS as the predictors of morbidity and mortality at initial hospitalization.
In this retrospective cohort study, we enrolled 159 patients with cirrhosis (median age: 49 years, 70.4% males). The role of Child-Pugh-Turcotte (CPT) score, MELD score, and SIRS on mortality was determined by the Kaplan-Meier method, and the prognosis factors were assessed with Cox regression model.
At initial hospitalization, 74.2%, 20.1%, and 37.7% of the patients with cirrhosis showed the presence of ascites, hepatorenal syndrome, and esophageal varices, respectively. During the in-hospital follow-up, 40 (25.2%) patients died. The overall incidence of mortality was found to be 3.1 [95% confidence interval (CI): 2.2-4.1] per 100 person-days. Survival probabilities were found to be high in case of patients who were SIRS negative (log-rank test= 4.51, =0.03) and in case of patients with MELD score ≤16 (log-rank test=7.26, =0.01) compared to the patients who were SIRS positive and those with MELD score >16. Only SIRS (hazard ratio (HR)=3.02, [95% CI: 1.4-7.4], =0.01) and MELD score >16 (HR=2.2, [95% CI: 1.1-4.3], =0.02) were independent predictors of mortality in multivariate analysis except CPT, which was not relevant in our study. Patients with MELD score >16 experienced hepatorenal syndrome (=0.002) and encephalopathy (=0.001) more frequently than that of patients with MELD score ≤16. SIRS was not useful in predicting complications.
MELD score and SIRS can be used as tools for the prediction of mortality in black African patients with decompensated cirrhosis.
全身炎症反应综合征（SIRS）和终末期肝病模型（MELD）可预测肝硬化患者的短期死亡率。在失代偿期肝硬化的非洲黑人患者中，初始住院时死亡率的预测尚不清楚。
本研究旨在探讨MELD评分和SIRS作为初始住院时发病率和死亡率预测指标的作用。
在这项回顾性队列研究中，我们纳入了159例肝硬化患者（中位年龄：49岁，70.4%为男性）。采用Kaplan-Meier法确定Child-Pugh-Turcotte（CPT）评分、MELD评分和SIRS对死亡率的影响，并使用Cox回归模型评估预后因素。
在初始住院时，分别有74.2%、20.1%和37.7%的肝硬化患者出现腹水、肝肾综合征和食管静脉曲张。在住院随访期间，40例（25.2%）患者死亡。发现总体死亡率为每100人日3.1[95%置信区间（CI）：2.2-4.1]。与SIRS阳性患者和MELD评分>16的患者相比，SIRS阴性患者（对数秩检验=4.51，P=0.03）和MELD评分≤16的患者（对数秩检验=7.26，P=0.01）的生存概率较高。在多变量分析中，除CPT（在我们的研究中不相关）外，只有SIRS（风险比（HR）=3.02，[95%CI：1.4-7.4]，P=0.01）和MELD评分>16（HR=2.2，[95%CI：1.1-4.3]，P=0.02）是死亡率的独立预测因素。MELD评分>16的患者比MELD评分≤16的患者更频繁地发生肝肾综合征（P=0.002）和肝性脑病（P=0.001）。SIRS对预测并发症无用。
MELD评分和SIRS可作为预测失代偿期肝硬化非洲黑人患者死亡率的工具。
