新型CABIN评分在预测挽救性经颈静脉肝内门体分流术后院内死亡率方面优于其他预后模型。
Novel CABIN score outperforms other prognostic models in predicting in-hospital mortality after salvage transjugular intrahepatic portosystemic shunting.
作者信息
Krige Jake, Jonas Eduard, Robinson Chanel, Beningfield Steve, Kotze Urda, Bernon Marc, Burmeister Sean, Kloppers Christo
机构信息
Department of Surgical Gastroenterology, University of Cape Town Health Sciences Faculty, Cape Town 7925, Western Cape, South Africa.
Department of Radiology, University of Cape Town Health Sciences Faculty, Cape Town 7925, Western Cape, South Africa.
出版信息
World J Gastrointest Pathophysiol. 2023 Mar 22;14(2):34-45. doi: 10.4291/wjgp.v14.i2.34.
BACKGROUND
Transjugular intrahepatic portosystemic shunt (TIPS) is now established as the salvage procedure of choice in patients who have uncontrolled or severe recurrent variceal bleeding despite optimal medical and endoscopic treatment.
AIM
To analysis compared the performance of eight risk scores to predict in-hospital mortality after salvage TIPS (sTIPS) placement in patients with uncontrolled variceal bleeding after failed medical treatment and endoscopic intervention.
METHODS
Baseline risk scores for the Acute Physiology and Chronic Health Evaluation (APACHE) II, Bonn TIPS early mortality (BOTEM), Child-Pugh, Emory, FIPS, model for end-stage liver disease (MELD), MELD-Na, and a novel 5 category CABIN score incorporating Creatinine, Albumin, Bilirubin, INR and Na, were calculated before sTIPS. Concordance (C) statistics for predictive accuracy of in-hospital mortality of the eight scores were compared using area under the receiver operating characteristic curve (AUROC) analysis.
RESULTS
Thirty-four patients (29 men, 5 women), median age 52 years (range 31-80) received sTIPS for uncontrolled (11) or refractory (23) bleeding between August 1991 and November 2020. Salvage TIPS controlled bleeding in 32 (94%) patients with recurrence in one. Ten (29%) patients died in hospital. All scoring systems had a significant association with in-hospital mortality ( < 0.05) on multivariate analysis. Based on in-hospital survival AUROC, the CABIN (0.967), APACHE II (0.948) and Emory (0.942) scores had the best capability predicting mortality compared to FIPS (0.892), BOTEM (0.877), MELD Na (0.865), Child-Pugh (0.802) and MELD (0.792).
CONCLUSION
The novel CABIN score had the best prediction capability with statistical superiority over seven other risk scores. Despite sTIPS, hospital mortality remains high and can be predicted by CABIN category B or C or CABIN scores > 10. Survival was 100% in CABIN A patients while mortality was 75% for CABIN B, 87.5% for CABIN C, and 83% for CABIN scores > 10.
背景
经颈静脉肝内门体分流术（TIPS）现已成为尽管接受了最佳药物和内镜治疗，但仍有无法控制的或严重复发性静脉曲张出血的患者的首选挽救治疗方法。
目的
分析比较八种风险评分在预测药物治疗和内镜干预失败后出现无法控制的静脉曲张出血的患者接受挽救性TIPS（sTIPS）置入术后院内死亡率方面的表现。
方法
在进行sTIPS之前，计算急性生理与慢性健康状况评估（APACHE）II、波恩TIPS早期死亡率（BOTEM）、Child-Pugh、埃默里、FIPS、终末期肝病模型（MELD）、MELD-Na以及一种包含肌酐、白蛋白、胆红素、国际标准化比值（INR）和钠的新型5分类CABIN评分的基线风险评分。使用受试者工作特征曲线下面积（AUROC）分析比较这八种评分对院内死亡率预测准确性的一致性（C）统计量。
结果
1991年8月至2020年11月期间，34例患者（29例男性，5例女性），中位年龄52岁（范围31 - 80岁）因无法控制的（11例）或难治性的（23例）出血接受了sTIPS治疗。挽救性TIPS使32例（94%）患者出血得到控制，其中1例复发。10例（29%）患者在院内死亡。多因素分析显示，所有评分系统均与院内死亡率有显著相关性（<0.05）。基于院内生存AUROC，与FIPS（0.892）、BOTEM（0.877）、MELD-Na（0.865）、Child-Pugh（0.802）和MELD（0.792）相比，CABIN（0.967）、APACHE II（0.948）和埃默里（0.942）评分预测死亡率的能力最佳。
结论
新型CABIN评分具有最佳预测能力，在统计学上优于其他七种风险评分。尽管有sTIPS治疗，但院内死亡率仍然很高，可通过CABIN B类或C类或CABIN评分>10来预测。CABIN A类患者的生存率为100%，而CABIN B类患者的死亡率为75%，CABIN C类患者为87.5%，CABIN评分>10的患者为83%。
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