Orrego H, Israel Y, Blake J E, Medline A
Hepatology. 1983 Nov-Dec;3(6):896-905. doi: 10.1002/hep.1840030602.
The prognostic significance of a battery of clinical, laboratory, and histological indicators was assessed in relation to mortality risk in a 1-year study of 253 patients with alcoholic liver disease, of whom 51 died within such time. The relative risk associated with each abnormality was calculated. A number of abnormalities was found to be statistically associated with a higher risk of death. Among the clinical abnormalities, these were: collateral circulation, edema, ascites, encephalopathy, spider nevi, anorexia, and weakness. Among the laboratory tests, these were: albumin, bilirubin, hemoglobin, abnormal prothrombin time, and alkaline phosphatase. Two hundred and sixteen of these patients had liver biopsies in which the quantifiable abnormalities were scored. Among the histological findings, the alterations significantly related to mortality were necrosis, Mallory, and inflammation, while the presence of cirrhosis per se did not influence the mortality risk. The relative risk factors for mortality associated with the histological alterations were lower than those derived from clinical or laboratory measurements. The advantage of using only clinical and laboratory items to derive a global, quantitative expression of severity is discussed. The relative mortality risks provided a means of calculating a "unit of severity" for each clinical and laboratory abnormality. A combined clinical and laboratory index (CCLI) results when these mortality-risk units are added. Such a combined index had a quasi-linear relationship with the risk of mortality for the complete population. This method compared well with severity scores derived from computerized, linear step-wise discriminant function (SDF) analysis and from a logistic regression (LR) analysis. The factors chosen to have independent prognostic significance by the SDF analysis were: encephalopathy, albumin, prothrombin time, and hemoglobin, while only encephalopathy, albumin, and hemoglobin were chosen by the LR analysis. Within a range of values, LR can provide a good discrimination in relation to mortality, similar to that observed for the CCLI in its complete range. However, there are some advantages to the CCLI method vs. the LR or SDF analyses. The CCLI is less susceptible to being unduly influenced by a nonspecific effect of treatment on the items chosen than the SDF and LR analyses, as the CCLI contains a large number of factors. Obtaining a single-severity score such as the CCLI is of value in: (a) assessing the effectiveness of treatment modalities; (b) analyzing the success of randomization; (c) separating cohorts of different severity, and (d) comparing new liver tests, histological abnormalities, or specific biological events with the severity of alcoholic liver disease.
在一项针对253例酒精性肝病患者的为期1年的研究中，评估了一系列临床、实验室和组织学指标与死亡风险的预后相关性，其中51例患者在此期间死亡。计算了与每种异常相关的相对风险。发现一些异常与较高的死亡风险在统计学上相关。在临床异常中，这些包括：侧支循环、水肿、腹水、脑病、蜘蛛痣、厌食和虚弱。在实验室检查中，这些包括：白蛋白、胆红素、血红蛋白、凝血酶原时间异常和碱性磷酸酶。其中216例患者进行了肝活检，并对可量化的异常进行了评分。在组织学发现中，与死亡率显著相关的改变是坏死、马洛里小体和炎症，而肝硬化本身的存在并不影响死亡风险。与组织学改变相关的死亡相对风险因素低于临床或实验室测量得出的因素。讨论了仅使用临床和实验室指标得出严重程度的整体定量表达的优势。相对死亡风险提供了一种计算每个临床和实验室异常的“严重程度单位”的方法。当这些死亡风险单位相加时，就得到了一个临床和实验室综合指数（CCLI）。这样一个综合指数与整个人群的死亡风险具有准线性关系。该方法与通过计算机化的线性逐步判别函数（SDF）分析和逻辑回归（LR）分析得出的严重程度评分相比效果良好。SDF分析选择的具有独立预后意义的因素为：脑病、白蛋白、凝血酶原时间和血红蛋白，而LR分析仅选择了脑病、白蛋白和血红蛋白。在一定值范围内，LR在区分死亡方面可以提供良好的效果，类似于CCLI在其整个范围内观察到的情况。然而，与LR或SDF分析相比，CCLI方法有一些优势。由于CCLI包含大量因素，它比SDF和LR分析更不容易受到治疗对所选指标的非特异性影响的过度影响。获得像CCLI这样的单一严重程度评分在以下方面具有价值：（a）评估治疗方式的有效性；（b）分析随机化的成功情况；（c）区分不同严重程度的队列；以及（d）将新的肝脏检查、组织学异常或特定生物学事件与酒精性肝病的严重程度进行比较。
