Establishment of a scoring system for evaluating the severity of hepatitis B patients with acute-on-chronic liver failure
10.3760/cma.j.issn.1000-6680.2010.05.011
- VernacularTitle:乙型肝炎慢加急性肝功能衰竭严重程度评估的预后评分系统的建立
- Author:
Tianhuang LIU
;
Jianyun ZHU
;
Shaoquan ZHANG
;
Shibin XIE
;
Weimin KE
;
Zhiliang GAO
- Publication Type:Journal Article
- Keywords:
Hepatitis B;
Liver failure;
Prognosis;
Severity of illness index;
Models,theoretical
- From:
Chinese Journal of Infectious Diseases
2010;28(5):293-296
- CountryChina
- Language:Chinese
-
Abstract:
Objective To establish a scoring system for evaluating the severity of hepatitis B patients with acute-on-chronic liver failure and to compare the validity of this system with model for end-stage liver disease (MELD). Methods MELD score was used in hepatitis B patients with acuteon-chronic liver failure who were divided into survival group (203 cases) and death group (196 cases).Seven clinical relative indices, including prothrombin activity, serum creatinine, hepatic encephalopathy, accompanying infections, serum total bilirubin, the dimension of liver, the amount of ascites, were selected for evaluating the severity. Each index was graded with 1 to 4 points based on the severity. Then the total score was counted by adding up scores of each index. T test and area under receiver operating characteristic (ROC) were used to evaluate the difference and similarity of the two systems. Results According to the new scoring system, the total score was 8. 07±3. 14 in the survival group and 16. 91 ±3. 54 in the death group. There was a statistically significant difference between these two groups (t = 26.125. P<0.01). In 81.32% of survival patients, their scores ranged from 3.91 to 12.23, while in 81.32% of dead patients, their scores ranged from 12.23 to 21.60. The two ranges overlapped at 12.23. According to the MELD system, the total score was 26. 43 ±5. 58 in the survival group and 40. 16 ±10. 22 in the death group. The difference between the two groups was statistically different (t = 16. 566, P<0. 01). In 61.02% of survival patients, the MELD scores ranged from 21. 49 to 31. 19, while in 61. 02% of the dead patients, the MELD scores ranged from 31. 19 to 48. 94. The two ranges overlapped at 31.19. The areas under ROC of the new scoring system and MELD system were 0.960 (95% CI: 0. 944-0. 977) and 0.886 (95% C/;0. 852 - 0. 920). No overlap was found in these two 95%CJ and there was a statistically significant difference. Conclusions The new scoring system is applicable for evaluating the severity and prognosis of acute-on-chronic liver failure in hepatitis B patients. The sensitivity of this new scoring system is approximate to the MELD system.
