三种评分系统对肝硬化食管胃底静脉曲张破裂出血患者的风险评估

中华消化内镜杂志 Pub Date : 2020-02-20 DOI:10.3760/CMA.J.ISSN.1007-5232.2020.02.006

Zhengyan Su, Chao Sun, X. Jiang, Ya Wang, You Deng, Bangmao Wang

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引用次数: 1

摘要

目的比较终末期肝病模型(MELD)、glasgow-blatchford评分(GBS)和AIMS65评分系统对肝硬化食管胃静脉曲张出血(EGVB)患者的风险评估能力。方法回顾性分析2015年1月1日至2018年3月1日天津医科大学总医院消化内科收治的182例肝硬化合并EGVB患者的资料。根据MELD、GBS和AIMS65评分系统，计算每位患者相应的评分，评估三种评分系统正确将EGVB分类为“高危患者”的能力。绘制受试者工作特征曲线，比较三种评分系统对不同临床结果(输血、再出血和死亡)的预测价值。曲线下面积(AUC)>0.7被认为具有较高的精度。结果182例患者的临床结局包括输血113例(62.1%)，再出血31例(17.0%)，死亡11例(6.0%)。MELD评分为7-25分，GBS评分为3-16分，AIMS65评分为0-3分。MELD评分< 9的患者4例(2.2%)，AIMS65评分为0-1的患者139例(76.4%)，其中AIMS65评分为0的患者68例，AIMS65评分为1的患者71例。MELD、GBS和AIMS65预测输血的AUC分别为0.514 (95%CI: 0.439 ~ 0.589)、0.681 (95%CI: 0.608 ~ 0.748)和0.669 (95%CI: 0.596 ~ 0.737)。预测再出血时，MELD、GBS和AIMS65的AUC分别为0.525 (95%CI: 0.449 ~ 0.599)、0.528 (95%CI: 0.453 ~ 0.602)和0.580 (95%CI: 0.505 ~ 0.652)。在预测院内死亡率时，MELD、GBS和AIMS65的AUC分别为0.642 (95%CI: 0.567-0.711)、0.581 (95%CI: 0.505-0.653)和0.786 (95%CI: 0.719-0.843)。AIMS65优于MELD (P=0.083 6)和GBS (P=0.047 0)。结论GBS能正确地将肝硬化合并EGVB患者划分为“高危组”，且优于AIMS65和MELD评分系统。MELD、GBS和AIMS65对输血和再出血的预测准确性均较差，AIMS65对死亡的预测价值较高。关键词:预后;肝硬化;食管胃静脉曲张出血;评分系统

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Risk assessment of cirrhosis patients with esophageal and gastric variceal bleeding by three scoring systems

Objective To compare the risk assessment capability of model for end-stage liver disease (MELD), glasgow-blatchford score (GBS), and the AIMS65 scoring system for liver cirrhosis patients with esophageal and gastric variceal bleeding (EGVB). Methods A retrospective analysis was made on data of 182 cirrhosis patients with EGVB admitted to the Department of Gastroenterology, General Hospital of Tianjin Medical University from January 1, 2015 to March 1, 2018. According to the MELD, GBS and AIMS65 scoring system, the corresponding scores of each patient were calculated to evaluate the ability of the three scoring systems to correctly classify EGVB as a " high-risk patient" . The receiver operating characteristic curve was drawn to compare the predictive value of three scoring systems for different clinical outcomes (blood transfusion, rebleeding, and death). The area under curve (AUC)>0.7 was believed to have higher accuracy. Results The clinical outcomes of 182 patients included blood transfusion in 113 (62.1%) cases, rebleeding in 31 (17.0%) cases, and death of 11 (6.0%) cases. The MELD score was 7-25, GBS was 3-16, and AIMS65 score was 0-3. There were 4 (2.2%) patients with MELD score < 9, 139 (76.4%) patients with AIMS65 score 0-1, including 68 patients with AIMS65 score of 0 and 71 patients with AIMS65 score of 1. The AUC of MELD, GBS and AIMS65 for predicting blood transfusion was 0.514 (95%CI: 0.439-0.589), 0.681 (95%CI: 0.608-0.748), and 0.669 (95%CI: 0.596-0.737), respectively. When predicting rebleeding, the AUC of MELD, GBS and AIMS65 was 0.525 (95%CI: 0.449-0.599), 0.528 (95%CI: 0.453-0.602) and 0.580 (95%CI: 0.505-0.652), respectively. When predicting in-hospital mortality, the AUC of MELD, GBS and AIMS65 was 0.642 (95%CI: 0.567-0.711), 0.581 (95%CI: 0.505-0.653) and 0.786 (95%CI: 0.719-0.843), respectively. AIMS65 was superior to MELD (P=0.083 6) and GBS (P=0.047 0). Conclusion GBS can correctly classify cirrhosis patients with EGVB as " high-risk group" , and is better than AIMS65 and MELD scoring system. MELD, GBS and AIMS65 all have poor accuracy in predicting blood transfusion and rebleeding, AIMS65 has a higher predictive value for death. Key words: Prognosis; Liver cirrhosis; Esophageal and gastric variceal bleeding; Scoring system

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来源期刊

中华消化内镜杂志

CiteScore

0.10

自引率

0.00%

发文量

7555

期刊介绍： Chinese Journal of Digestive Endoscopy is a high-level medical academic journal specializing in digestive endoscopy, which was renamed Chinese Journal of Digestive Endoscopy in August 1996 from Endoscopy. Chinese Journal of Digestive Endoscopy mainly reports the leading scientific research results of esophagoscopy, gastroscopy, duodenoscopy, choledochoscopy, laparoscopy, colorectoscopy, small enteroscopy, sigmoidoscopy, etc. and the progress of their equipments and technologies at home and abroad, as well as the clinical diagnosis and treatment experience. The main columns are: treatises, abstracts of treatises, clinical reports, technical exchanges, special case reports and endoscopic complications. The target readers are digestive system diseases and digestive endoscopy workers who are engaged in medical treatment, teaching and scientific research. Chinese Journal of Digestive Endoscopy has been indexed by ISTIC, PKU, CSAD, WPRIM.