Llach J, Ginès P, Arroyo V, Rimola A, Titó L, Badalamenti S, Jiménez W, Gaya J, Rivera F, Rodés J
Liver Unit, Hospital Clínic i Provincial, University of Barcelona, Spain.
Gastroenterology. 1988 Feb;94(2):482-7. doi: 10.1016/0016-5085(88)90441-6.
To identify prognostic factors in cirrhotic patients admitted to the hospital for the treatment of an episode of ascites, a survival analysis was performed in a series of 139 patients hospitalized in our Unit between 1980 and 1985. Mean follow-up was 12.8 +/- 14.2 mo (mean +/- SD). A total of 38 variables based on history, physical examination, hepatic biochemical tests, renal function tests, and endogenous vasoactive systems were analyzed for prognostic value. Eighteen of these variables had prognostic value in the univariate analysis. A multivariate analysis (Cox's regression method) disclosed that 7 of these 18 variables had independent prognostic value. Of these independent predictors of survival, mean arterial pressure and plasma norepinephrine concentration were the variables that best predicted prognosis. Two other variables that independently correlated with survival were urinary sodium excretion and glomerular filtration rate. The remaining three independent predictors of survival were nutritional status, hepatomegaly, and serum albumin concentration. Therefore, these findings indicate that, in patients with cirrhosis and ascites, parameters estimating systemic hemodynamics and renal function are better predictors of survival than those routinely used to estimate hepatic function.
为了确定因腹水发作入院治疗的肝硬化患者的预后因素，我们对1980年至1985年间在本单位住院的139例患者进行了生存分析。平均随访时间为12.8±14.2个月（均值±标准差）。基于病史、体格检查、肝脏生化检查、肾功能检查和内源性血管活性系统共分析了38个变量的预后价值。其中18个变量在单因素分析中有预后价值。多因素分析（Cox回归法）显示，这18个变量中有7个具有独立的预后价值。在这些生存的独立预测因素中，平均动脉压和血浆去甲肾上腺素浓度是最能预测预后的变量。另外两个与生存独立相关的变量是尿钠排泄和肾小球滤过率。其余三个生存的独立预测因素是营养状况、肝肿大和血清白蛋白浓度。因此，这些研究结果表明，在肝硬化腹水患者中，评估全身血流动力学和肾功能的参数比常规用于评估肝功能的参数更能预测生存。
