Del Val A, Garrrigues V, Ponce J, Berenguer J
Servicio de Medicina Digestiva, Hospital La Fe, Valencia.
Rev Esp Enferm Dig. 1995 Dec;87(12):859-64.
Our aim was to develop and validate a prognostic model to predict the evolution of cirrhotic patients admitted to the hospital because of ascites and treated with diuretics. Two hundred and two patients were evaluated. After collection of clinical and laboratory data, a prognosis of the response to diuretics was given by one of us. After univariate analysis, 37 parameters were used to construct a database. A new prognosis was obtained for each patient comparing his/her data with the database, with the help of a computer and using Bayes' theorem. Gender: female, poor general status, disturbed consciousness, increased serum glucose, increased BUN, low prothrombin time, increased bilirubin, leucocytosis, thrombopenia and low urine sodium were associated with a poor response to diuretics. Sensitivity and specificity of clinical and computer prognosis were similar. Computer prognosis allowed the classification of patients in groups of risk which showed a different evolution and improved the accuracy of the clinical prognosis. We conclude that the objective analysis of clinical and laboratory data is useful to improve the accuracy of the prediction of the evolution in cirrhotic patients with ascites treated with diuretics.
我们的目标是开发并验证一种预后模型，以预测因腹水入院并接受利尿剂治疗的肝硬化患者的病情发展。对202例患者进行了评估。在收集临床和实验室数据后，由我们其中一人给出对利尿剂反应的预后判断。经过单因素分析，使用37个参数构建了一个数据库。借助计算机并运用贝叶斯定理，将每位患者的数据与数据库进行比较，从而得出每位患者的新预后。性别为女性、一般状况差、意识障碍、血糖升高、血尿素氮升高、凝血酶原时间缩短、胆红素升高、白细胞增多、血小板减少以及尿钠降低与利尿剂反应不佳相关。临床预后和计算机预后的敏感性和特异性相似。计算机预后能够将患者分为不同风险组，这些组显示出不同的病情发展情况，并且提高了临床预后的准确性。我们得出结论，对临床和实验室数据进行客观分析有助于提高对接受利尿剂治疗的肝硬化腹水患者病情发展预测的准确性。
