Butt A K, Khan A A, Alam A, Shah S W, Shafqat F, Naqvi A B
Department of Gastroenterology, Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan.
Am J Gastroenterol. 1998 Dec;93(12):2469-75. doi: 10.1111/j.1572-0241.1998.00706.x.
The severity of hepatic abnormalities and extent of dysfunction of other organ systems influences prognosis for cirrhosis. The Child-Pugh system has been used to classify cirrhotic patients into good, intermediate, or poor risk categories in evaluation and therapy. Disregard for cardiorespiratory, renal, electrolyte balance, and acid base status limits its predictive accuracy. We evaluated the accuracy of Acute Physiology and Chronic Health Evaluation (APACHE III) to predict short term hospital mortality in patients with liver cirrhosis.
A total of 282 patients were prospectively enrolled. Child-Pugh and APACHE III scores were recorded on day 1 for each patient.
Mean age was 51.7+/-11.3 yr, with 65% men and 35% women; 57% presented with upper GI bleeding, 47% encephalopathy, 9% hepatorenal syndrome, and 7% hepatocellular carcinoma. Sixty-three patients (22%) died. Major causes of death were upper GI bleeding 38%, liver failure 21%, hepatorenal syndrome 19%, hepatocellular carcinoma 4%, and spontaneous bacterial peritonitis 6%. Child-Pugh and APACHE III scores for survivors (8.6+/-2.3 and 58.9+/-35.1) were lower than those for nonsurvivors (10.9+/-2.7 and 87.4+/-30.3) (p < 0.001). Using discriminant analysis, APACHE III correctly identified 75% of cases vs 67% of cases for Child-Pugh (p < 0.05). When information regarding ascites and prothrombin time was added to APACHE III, 81% of cases were correctly classified.
The APACHE III scoring system is superior to Child-Pugh for prognosticating short term survival of cirrhotic patients. Prognostic accuracy of APACHE III can be enhanced by incorporating information regarding ascites and prothrombin time prolongation.
肝脏异常的严重程度以及其他器官系统功能障碍的程度会影响肝硬化的预后。Child-Pugh系统已被用于在评估和治疗中将肝硬化患者分为低、中、高风险类别。然而，该系统未考虑心肺、肾脏、电解质平衡及酸碱状态，限制了其预测准确性。我们评估了急性生理学与慢性健康状况评估系统（APACHE III）预测肝硬化患者短期住院死亡率的准确性。
前瞻性纳入282例患者。于第1天记录每位患者的Child-Pugh和APACHE III评分。
平均年龄为51.7±11.3岁，男性占65%，女性占35%；57%的患者出现上消化道出血，47%出现肝性脑病，9%出现肝肾综合征，7%出现肝细胞癌。63例患者（22%）死亡。主要死亡原因包括：上消化道出血38%，肝衰竭21%，肝肾综合征19%，肝细胞癌4%，自发性细菌性腹膜炎6%。存活者的Child-Pugh和APACHE III评分（分别为8.6±2.3和58.9±35.1）低于非存活者（分别为10.9±2.7和87.4±30.3）（p<0.001）。采用判别分析，APACHE III正确识别了75%的病例，而Child-Pugh系统为67%（p<0.05）。当将腹水和凝血酶原时间的信息加入APACHE III时，81%的病例能被正确分类。
在预测肝硬化患者短期生存方面，APACHE III评分系统优于Child-Pugh系统。纳入腹水和凝血酶原时间延长的信息可提高APACHE III的预后准确性。
