Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of South Carolina, Charelston, South Carolina, USA.
J Investig Med. 2018 Aug;66(6):992-997. doi: 10.1136/jim-2018-000709. Epub 2018 May 14.
Scoring systems such as Model for End-stage Liver Disease (MELD) and Child-Pugh are often used by clinicians to determine prognosis in patients with cirrhosis. Since clinical complications are important in determining cirrhosis outcomes, our goal was to use these to develop a novel prognostic staging model. Data from the Nationwide Inpatient Sample (NIS), years 2003-2011, were queried for records of patients over the age of 18 with cirrhosis excluding patients with prior or inpatient liver transplantation. The primary outcome was inpatient mortality with focus on cirrhosis-related complications: non-bleeding esophageal varices, variceal hemorrhage, ascites, hepatic encephalopathy (HE), spontaneous bacterial peritonitis (SBP), and hepatorenal syndrome (HRS). Of 59 862 903 hospitalizations, 824 783 (1.4%) with cirrhosis were identified. Overall mortality was 7% with two-thirds (66%) of deaths occurring in patients with a decompensating event, defined as variceal hemorrhage, ascites, HE, SBP, and/or HRS. Overall mortality rates decreased from 2003 to 2011 (9.0-6.0%), in both compensated and decompensated groups. Mortality was higher in patients with variceal haemorrhage (OR 1.56; p<0.05), HE (OR 1.75; p<0.05), SBP (OR 2.64; p<0.05) and HRS (OR 9.10; p<0.05) compared with patients with no complications. HRS had the highest mortality, whether alone or in combination with another event such as HE (OR 12.40; p<0.05) or SBP (OR 12.64; p<0.05). Cirrhosis inpatient outcomes are related to the severity of liver disease, with more severe complications such as HE, SBP, and HRS having the most significant effect on inpatient mortality, and are utilised in this novel four-stage clinical model.
评分系统，如终末期肝病模型（MELD）和 Child-Pugh，常被临床医生用于确定肝硬化患者的预后。由于临床并发症在确定肝硬化结局方面很重要，我们的目标是利用这些并发症来开发一种新的预后分期模型。从 2003 年至 2011 年，从全国住院患者样本（NIS）中查询了年龄在 18 岁以上且无既往或住院肝移植的肝硬化患者记录。主要结果是住院死亡率，重点关注肝硬化相关并发症：非出血性食管静脉曲张、静脉曲张出血、腹水、肝性脑病（HE）、自发性细菌性腹膜炎（SBP）和肝肾综合征（HRS）。在 59862903 例住院患者中，有 824783 例（1.4%）被诊断为肝硬化。总死亡率为 7%，其中三分之二（66%）的死亡发生在失代偿事件患者中，失代偿事件定义为静脉曲张出血、腹水、HE、SBP 和/或 HRS。2003 年至 2011 年，无论在代偿组还是失代偿组，总死亡率均呈下降趋势（9.0%至 6.0%）。静脉曲张出血（OR 1.56；p<0.05）、HE（OR 1.75；p<0.05）、SBP（OR 2.64；p<0.05）和 HRS（OR 9.10；p<0.05）患者的死亡率均高于无并发症患者。与其他事件（如 HE 或 SBP）组合发生的 HRS 具有最高的死亡率（OR 12.40；p<0.05）。肝硬化住院患者的结局与肝病的严重程度有关，更严重的并发症，如 HE、SBP 和 HRS，对住院死亡率的影响最大，且用于本新型四期临床模型。
