Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
BMC Gastroenterol. 2023 Jun 1;23(1):190. doi: 10.1186/s12876-023-02813-4.
Liver cirrhosis is the final stage of chronic liver disease. Complications due to progression of liver disease may deteriorate the liver function and worsen prognosis. Previous studies have shown that patients with liver cirrhosis are at increased risk of death within 90-day after hospitalization. It is necessary to identify patients who are at higher risk of early mortality. This study aims to develop a scoring system to predict the 90-day mortality among hospitalized patients with liver cirrhosis that could be used for modification of treatment plan according to the scores that have been obtained. By using this scoring system, crucial care of plans can be taken to reduce the risk of mortality.
This prospective cohort study was conducted on hospitalized cirrhotic patients at Cipto Mangunkusumo National General Hospital, Jakarta. Demographic, clinical, and laboratory data were recorded. Patients were monitored for up to 90-day after hospitalization to determine their condition. Cox regression analysis was performed to obtain predictor factors contributing to mortality in liver cirrhosis patients. The scoring system that resulted from this study categorized patients into low, moderate, and high-risk categories based on their predicted mortality rates. The sensitivity and specificity of the scoring system were evaluated using the AUC (area under the curve) metric.
The study revealed that liver cirrhosis patients who were hospitalized had a 90-day mortality rate of 42.2%, with contributing factors including Child-Pugh, MELD, and leukocyte levels. The combination of these variables had a good discriminative value with an AUC of 0.921 (95% CI: 0.876-0.967). The scoring system resulted in three risk categories: low risk (score of 0-3) with a 4.1-18.4% probability of death, moderate risk (score of 5-6) with a 40.5-54.2% probability of death, and high risk (score of 8-11) with a 78.1-94.9% probability of death.
The scoring system has shown great accuracy in predicting 90-day mortality in hospitalized cirrhosis patients, making it a valuable tool for identifying the necessary care and interventions needed for these patients upon admission.
肝硬化是慢性肝病的终末期阶段。由于肝病进展而引起的并发症可能会使肝功能恶化并降低预后。先前的研究表明，肝硬化患者在住院后 90 天内死亡的风险增加。因此，有必要识别出那些有更高早期死亡风险的患者。本研究旨在开发一种评分系统，以预测住院肝硬化患者的 90 天死亡率，以便根据获得的评分来修改治疗计划。通过使用该评分系统，可以采取关键的护理计划来降低死亡率。
这是一项在雅加达 Cipto Mangunkusumo 国家综合医院进行的前瞻性队列研究，纳入了住院的肝硬化患者。记录了人口统计学、临床和实验室数据。对患者进行了长达 90 天的监测，以确定他们的病情。采用 Cox 回归分析确定与肝硬化患者死亡相关的预测因素。该研究产生的评分系统根据预测死亡率将患者分为低危、中危和高危人群。使用 AUC（曲线下面积）评估该评分系统的敏感性和特异性。
研究表明，住院肝硬化患者的 90 天死亡率为 42.2%，其相关因素包括 Child-Pugh、MELD 和白细胞水平。这些变量的组合具有很好的区分能力，AUC 为 0.921（95%CI：0.876-0.967）。评分系统将风险分为三个等级：低危（评分 0-3），死亡概率为 4.1-18.4%；中危（评分 5-6），死亡概率为 40.5-54.2%；高危（评分 8-11），死亡概率为 78.1-94.9%。
该评分系统在预测住院肝硬化患者 90 天死亡率方面具有很高的准确性，是一种有价值的工具，可以在患者入院时识别出他们所需的护理和干预措施。
