Predicting utility of a model for end stage liver disease in alcoholic liver disease

来源 :World Journal of Gastroenterology | 被引量 : 0次 | 上传用户:xiaoxianjihuoma
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AIM: To validate the statistic utility of both the Maddrey Discriminant Function score and the Model for End-Stage Liver Disease as predictors of short term (30 d and 90 d) mortality in patients with alcoholic hepatitis and to assess prognostic factors among clinical characteristics and laboratory variables of patients with alcoholic hepatitis. METHODS: Thirty-four patients with the diagnosis of alcoholic hepatitis admitted to Hippokration University Hospital of Athens from 2000 to 2005 were assessed in the current retrospective study and a statistical analysis was conducted. RESULTS: 30- and 90-d mortality rates were reported at 5.9% (2/34) and 14.7% (5/34), respectively. Significant correlation was demonstrated for the Model for End-Stage Liver Disease (P30=0.094, P90=0.046) and the Maddrey Discriminant Function score (P30= 0.033, P90= 0.038) with 30- and 90-d mortality whereas a significant association was also established for alanine aminotrans-ferase (P = 0.057), fibrin degradation products (P= 0.048) and C-reactive protein (P = 0.067) with 90-d mortality. For 30-d mortality the Area Under the Curve was 0.969 (95%CI: 0.902-1.036, P = 0.028) for the Model for End-Stage Liver Disease score and 0.984 (95%CI: 0.942-1.027, P = 0.023) for the Maddrey Discriminant Function score with the optimal cut off point of 30.5 (sensitivity 1, specificity 0.937) and 108.68 (sensitivity 1, specificity 0.969), respectively. Accordingly, for 90-d mortality the Area Under the Curve was 0.762 (95%CI: 0.559-0.965, P = 0.065) for the Model for End-Stage Liver Disease score and 0.752 (95%CI: 0.465-1.038, P = 0.076) for the Maddrey Discriminant Function score with the optimal cut off point of 19 (sensitivity 0.6, specificity 0.6) and 92 (sensitivity 0.6, specificity 0.946), respectively. The observed Kaplan Meier survival rates for different score-categories were compared with log-rank tests and higher score values were correlated with a lower survival. CONCLUSION: Equivalency of the Model for End-Stage Liver Disease and the Maddrey Discriminant Function score is implied by the current study, verified by the plotted Receiver Operative Curves and the estimated survival rates. A statistically significant utility of C-reactive protein, fibrin degradation products and alanine aminotrans-ferase as independent predictors of 90-d mortality has also been verified. AIM: To validate the statistic utility of both the Maddrey Discriminant Function score and the Model for End-Stage Liver Disease as predictors of short term (30 d and 90 d) mortality in patients with alcoholic hepatitis and to assess prognostic factors among clinical characteristics and METHODS: of patients with the diagnosis of alcoholic hepatitis admitted to Hippocampus University Hospital of Athens from 2000 to 2005 were assessed in the current retrospective study and a statistical analysis conducted conducted. RESULTS: 30- and Significant correlation was demonstrated for the Model for End-Stage Liver Disease (P30 = 0.094, P90 = 0.046) and the the 90-d mortality rates were reported at 5.9% (2/34) and 14.7% (5/34) Maddrey Discriminant Function score (P30 = 0.033, P90 = 0.038) with 30- and 90-d mortality an significant association was also established for alanine aminotrans-ferase (P = 0.057), fibrin degradatio For 30-d mortality the Area Under the Curve was 0.969 (95% CI: 0.902-1.036, P = 0.028) for the product (P = 0.048) and C-reactive protein Model for End-Stage Liver Disease score and 0.984 (95% CI: 0.942-1.027, P = 0.023) for the Maddrey Discriminant Function score with the optimal cut off point of 30.5 (sensitivity 1, specificity 0.937) and 108.68 (sensitivity 1, specificity 0.969), respectively. for 90-d mortality the Area Under the Curve was 0.762 (95% CI: 0.559-0.965, P = 0.065) for the Model for End- Stage Liver Disease score and 0.752 (95% CI: 0.465-1.038, P = 0.076) for the Maddrey Discriminant Function score with the optimal cut off point of 19 (sensitivity 0.6, specificity 0.6) and 92 (sensitivity 0.6, specificity 0.946), respectively. The observed Kaplan Meier survival rates for different score -categories were compared with log-rank tests and higher score values ​​were correlated with a lower survival. CONCLUSION: Equivalency of the Model for End-Stage Liver Disease and the Maddrey Discriminant Function score is implied by the current study, verified by the plotted Receiver Curves and the estimated survival rates. A significant gene utility of C-reactive protein, fibrin degradation products and alanine aminotrans- ferase as independent predictors of 90-d mortality has also been verified.
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