Department of Surgery, J45 OMB, University of Cape Town Health Sciences Faculty, Anzio Road, Observatory, Cape Town, 7925, South Africa.
Surgical Gastroenterology and HPB Unit, Groote Schuur Hospital, Cape Town, South Africa.
World J Surg. 2020 Jan;44(1):241-246. doi: 10.1007/s00268-019-05211-8.
There currently is no consensus on how to accurately predict early rebleeding and death after a major variceal bleed. This study investigated the relative predictive performances of the original Child-Pugh (CP), model for end-stage liver disease (MELD) and a four-category recalibrated Child-Pugh (rCP).
This prospective study included all adult patients admitted to Groote Schuur Hospital with acute esophageal variceal bleeding secondary to alcoholic cirrhosis, between January 2000 and December 2017. CP and rCP grades and MELD score were calculated on admission, and the predictive ability in discriminating in-hospital rebleeding and death was compared by area under receiver-operating characteristic (AUROC) curves.
During the study period, 403 consecutive adult patients were treated for bleeding esophageal varices of whom 225 were secondary to alcoholic cirrhosis. Twenty-four (10.6%) patients were CP grade A, 88 (39.1%) grade B and 113 (50.2%) grade C on hospital admission. MELD scores ranged from 6 to 40. Thirty-one (13.8%) patients rebleed, and 41 (18.2%) patients died. There was no difference in the discriminatory capacity of the CP (AUROC 0.59, 95% CI 0.50-0.670) and MELD (AUROC 0.62, 95% CI 0.51-0.73) to predict rebleeding (p = 0.72), or between the Child-Pugh (AUROC 0.75, 95% CI 0.71-0.81) and MELD (AUROC 0.71, 95% CI 0.62-0.80) to predict death (p = 0.35). The rCP classification (A-D) had a significantly improved discriminatory capacity (AUROC 0.83 95% CI 0.77-0.89) compared to the CP score (A-C) and MELD to predict death (p = 0.004).
A recalibrated Child-Pugh score outperforms the original Child-Pugh grade and MELD score in predicting in-hospital death in patients with bleeding esophageal varices secondary to alcoholic cirrhosis.
目前，对于如何准确预测大静脉曲张出血后早期再出血和死亡尚无共识。本研究旨在探讨原始 Child-Pugh（CP）、终末期肝病模型（MELD）和四分类校正 Child-Pugh（rCP）在预测中的相对表现。
这是一项前瞻性研究，纳入了 2000 年 1 月至 2017 年 12 月期间因酒精性肝硬化继发急性食管静脉曲张出血而入住 Groote Schuur 医院的所有成年患者。入院时计算 CP 和 rCP 分级和 MELD 评分，并通过接受者操作特征（ROC）曲线下面积（AUROC）比较预测住院内再出血和死亡的能力。
在研究期间，共连续治疗了 403 例因食管静脉曲张出血的成年患者，其中 225 例继发于酒精性肝硬化。24 例（10.6%）患者入院时 CP 分级为 A，88 例（39.1%）为 B，113 例（50.2%）为 C。MELD 评分范围为 6 至 40。31 例（13.8%）患者再出血，41 例（18.2%）患者死亡。CP（AUROC 0.59，95%CI 0.50-0.670）和 MELD（AUROC 0.62，95%CI 0.51-0.73）预测再出血的能力无差异（p=0.72），CP（AUROC 0.75，95%CI 0.71-0.81）和 MELD（AUROC 0.71，95%CI 0.62-0.80）预测死亡的能力也无差异（p=0.35）。rCP 分类（A-D）与 CP 评分（A-C）和 MELD 相比，预测死亡的区分能力（AUROC 0.83，95%CI 0.77-0.89）有显著改善（p=0.004）。
在预测酒精性肝硬化继发食管静脉曲张出血患者住院内死亡方面，校正后的 Child-Pugh 评分优于原始 Child-Pugh 分级和 MELD 评分。
