Huang Chien-Hao, Tseng Hsiao-Jung, Amodio Piero, Chen Yu-Ling, Wang Sheng-Fu, Chang Shang-Hung, Hsieh Sen-Yung, Lin Chun-Yen
Division of Hepatology, Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 33305, Taiwan.
.College of Medicine, Chang-Gung University, Taoyuan City 33305, Taiwan.
J Pers Med. 2020 Oct 22;10(4):186. doi: 10.3390/jpm10040186.
Classification of cirrhosis based on clinical stages is rapid and based on five stages at present. Two other relevant events, hepatic encephalopathy (HE) and spontaneous bacterial peritonitis (SBP), can be considered in a clinical perspective but no study has implemented a seven-stage classification and confirmed its value before. In addition, long-term validation of the Model for End-Stage Liver Disease (MELD) in large cohorts of patients with cirrhosis and comparison with clinical findings are insufficient. Therefore, we performed a study to address these items. From the Chang-Gung Research Database (CGRD), 20,782 patients with cirrhosis were enrolled for an historical survival study. The MELD score, the five-stage clinical score (i.e., occurrence of esophageal varices (EV), EV bleeding, ascites, sepsis) and a novel seven-stage clinical score (i.e., occurrence of EV, EV bleeding, ascites, sepsis, HE, SBP) were compared with their Cox models by receiver operating characteristic (ROC) analysis. The addition of HE and SBP to the seven-stage model had a 5% better prediction result than the five-stage model did in the survival ROC analysis. The result showed that the seven clinical stages are associated with an increased risk for mortality. However, the predicted performances of the seven-stage model and MELD system are likely equivalent. In conclusion, the study (i) proved that clinical staging of cirrhosis based on seven items/stages had higher prognostic value than the five-stage model and (ii) confirmed the validity of the MELD criteria vs. clinical assessment.
基于临床分期对肝硬化进行分类目前迅速且基于五个阶段。从临床角度可考虑另外两个相关事件，即肝性脑病（HE）和自发性细菌性腹膜炎（SBP），但此前尚无研究实施七阶段分类并证实其价值。此外，终末期肝病模型（MELD）在大量肝硬化患者队列中的长期验证以及与临床结果的比较并不充分。因此，我们开展了一项研究来解决这些问题。从长庚研究数据库（CGRD）中，纳入了20782例肝硬化患者进行历史性生存研究。通过受试者操作特征（ROC）分析，将MELD评分、五阶段临床评分（即食管静脉曲张（EV）的发生、EV出血、腹水、脓毒症）和一种新的七阶段临床评分（即EV的发生、EV出血、腹水、脓毒症、HE、SBP）与其Cox模型进行比较。在生存ROC分析中，七阶段模型中加入HE和SBP的预测结果比五阶段模型好5%。结果表明，七个临床阶段与死亡风险增加相关。然而，七阶段模型和MELD系统的预测性能可能相当。总之，该研究（i）证明基于七个项目/阶段的肝硬化临床分期比五阶段模型具有更高的预后价值，（ii）证实了MELD标准相对于临床评估的有效性。
