NHS Tayside, Dundee, UK
NHS Forth Valley, Stirling, UK.
BMJ Open Gastroenterol. 2022 Mar;9(1). doi: 10.1136/bmjgast-2021-000822.
Chronic liver disease continues to be a significant cause of morbidity and mortality yet remains challenging to prognosticate. This has been one of the barriers to implementing palliative care, particularly at an early stage. The Bristol Prognostic Score (BPS) was developed to identify patients with life expectancy less than 12 months and to act as a trigger for referral to palliative care services. This study retrospectively evaluated the BPS in a cohort of patients admitted to three Scottish hospitals.
Routinely collated healthcare data were used to obtain demographics, BPS and analyse 1-year mortality for patients with decompensated liver disease admitted to three gastroenterology units over two 90-day periods. Statistical analysis was undertaken to assess performance of BPS in predicting mortality.
276 patients were included in the final analysis. Participants tended to be late middle-aged men, socioeconomically deprived and have alcohol-related liver disease. A similar proportion was BPS+ve (>3) in this study compared with the original Bristol cohort though had more hospital admissions, higher ongoing alcohol use and poorer performance status. BPS performed poorer in this non-Bristol group with sensitivity 54.9% (72.2% in original study), specificity 58% (83.8%) and positive predictive value (PPV) 43.4% (81.3%).
BPS was unable to accurately predict mortality in this Scottish cohort. This highlights the ongoing challenge of prognostication in patients with chronic liver disease, furthering the call for more work in this field.
慢性肝病仍是发病率和死亡率的重要原因，但仍难以预测。这是实施姑息治疗的障碍之一，特别是在早期阶段。布里斯托预后评分（BPS）旨在识别预期寿命不足 12 个月的患者，并作为向姑息治疗服务转介的触发因素。本研究回顾性评估了三个苏格兰医院的患者队列中的 BPS。
使用常规收集的医疗保健数据获取人口统计学数据、BPS 并分析两个 90 天期间因失代偿性肝病入院的三个胃肠病学单位的患者的 1 年死亡率。进行统计分析以评估 BPS 在预测死亡率方面的性能。
最终分析纳入了 276 名患者。参与者倾向于为中老年男性，社会经济地位较低，患有酒精相关肝病。与原始布里斯托队列相比，本研究中 BPS+ve（>3）的比例相似，但住院次数更多，持续饮酒量更高，表现状态更差。BPS 在这个非布里斯托组中的表现较差，敏感性为 54.9%（原始研究中为 72.2%），特异性为 58%（83.8%），阳性预测值（PPV）为 43.4%（81.3%）。
BPS 无法准确预测苏格兰队列中的死亡率。这突显了慢性肝病患者预后预测的持续挑战，进一步呼吁在该领域开展更多工作。
