Value of five-stage prognostic system in predicting short-term outcome of patients with liver cirrhosis

• Main Author: TIAN Yan
• Format: Article
• Language: zho
• Published: Editorial Department of Journal of Clinical Hepatology 2015-03-01
• Series: Linchuang Gandanbing Zazhi
• Subjects: liver cirrhosis; prognosis; factor analysis; statistical
• Online Access: http://www.lcgdbzz.org/qk_content.asp?id=6372&ClassID=212131156
• ISSN: 1001-5256; 1001-5256

ObjectiveTo evaluate the clinical value of five-stage prognostic system in predicting the short-term outcome of patients with liver cirrhosis, and to compare it with the Child-Turcotte-Pugh (CTP) and Model of End-Stage Liver Disease (MELD) scores. MethodsTwo hundred and one hospitalized patients with liver cirrhosis in the Department of Gastroenterology in the First Affiliated Hospital of Anhui Medical University from January 2011 to January 2014 were enrolled in the study and followed up for at least six months. Patients were classified accorded to the five-stage prognostic system, and the mortality rate in each stage was measured. The receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC) were used to assess the accuracy of the five-stage prognostic system in predicting the short-term death risk of cirrhotic patients, which was then compared with the CTP and MELD scores. Categorical data were analyzed by chi-square test. Comparison of AUC was made by normal distribution Z test. Spearman′s correlation analysis was used to investigate the correlation of the five-stage prognostic system with the CTP and MELD scores. ResultsThe study used the admission time as the starting point and the death of patients or study termination time as the endpoint. Among the 201 patients, 50 (24.9%) died within six months. Based on the five-stage prognostic system, the mortality rates for stages 1 to 5 were 0(0/11), 0（0/18), 4.2%（2/48), 16.3% (7/43), and 50.6%（41/81), respectively. In patients with decompensated cirrhosis (stages 3, 4, and 5), the mortality increased with stage, and the differences in mortality between patients in stages 3 and 4, 3 and 5, and 4 and 5 were all significant (χ2=3.89, 35.33, and 13.96, respectively; P=0.049, 0.000, and 0.049, respectively). The AUC for the five-stage prognostic system, five-stage prognostic system combined with CTP and MELD score, and CTP score were 0820, 0.915, 0.888, and 0.809, respectively (P＜0.05). The five-stage prognostic system showed positive correlations with both CTP and MELD scores (r=0.772, P=0.000; r=0.479, P=0.000). ConclusionThe five-stage prognostic system based on portal hypertension complications is effective in predicting the short-term outcome of patients with decompensated liver cirrhosis. A combination of the five-stage prognostic system and the CTP and MELD scores can accurately predict the outcome of patients with liver cirrhosis.