Analysis of prognosis on patients with severe viral hepatitis using the model for end-stage liver disease / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To study the practical use of the model for end-stage liver disease (MELD) in clinics and to assess its validity in predicting the prognoses of patients with severe viral hepatitis and to determine the validity of the model by the concordance (c)-statistic which is equivalent to the area under the receiver operating characteristic (ROC) curve. Also, the optimal cutoff values of MELD to discriminate between deceased and surviving patients were calculated using ROC curves.</p><p><b>METHODS</b>121 patients were divided into a plasma exchange (PE) group and a non-plasma exchange (non-PE) group, and they were graded with the MELD formula. The death rate was observed within three months.</p><p><b>RESULTS</b>81 patients died within 3 months (35 cases in the PE group, 46 cases in the non-PE group). The mortality rates of patients in the PE group whose MELD scores were between 20 to 30 and 30 to 40 were 31.6% and 57.7% respectively, but in non-PE cases they were 67.6%, 81.3% respectively; there was a significant difference between the PE group and non-PE group. The mortality rates of patients whose MELD score was higher than 40 were 93.3% in the PE group and 100% in the non-PE group, however there was no significant difference between the two groups. The optimal cut-off values of MELD to predict the prognoses of patients were 30 in the PE group whose sensitivity, specificity and c-statistic were 80.0%, 52.0% and 0.777, but in the non-PE group they were 25, 82.6%, 86.7% and 0.869, respectively.</p><p><b>CONCLUSIONS</b>This study suggests that MELD scores can serve as an index of the severity of the disease of patients with severe viral hepatitis, and that the mortality rates of the patients increase with the increase of their MELD scores. MELD can accurately predict the short-term prognoses of patients with severe viral hepatitis.</p>

A randomized controlled clinical study of lower-dose peginterferon alfa-2b in combination with ribavirin in the treatment of chronic hepatitis C / 中华传染病杂志

Objective To compare the effecacy and safety of lower dose peginterferon alfa-2b plus ribavirin versus standard interferon alfa-2b plus ribavirin for treatment of chronic hepatitis C in China.Methods 192 patients with chronic hepatitis C were assigned peginterferon alfa-2b 0.5?g/kg each week plus ribavirin 750～1050 mg/d or standard interferon alfa-2b 3 MIU TIW plus ribavirin 750～1050 mg/d for 48-week treatment and 24-week fellow-up.Results The sustained virological response (SVR)rate in lowe-dose peginterferon alfa-2b plus ribavirin group was 53.8%,and the SVR rate in standard interferon alfa-2b plus ribavirin was 58.1%.The SVR was similar between the two treat- ment group(P=0.966 for both comparisons).The adverse event rate was higher in peginterferon al- fa-2b plus ribavirin group than in standard interferon alfa-2b plus ribavirin group(P=0.033 for both comparisons),but there was no new or unique adverse event in related to pegylation of interferon alfa-2b. Conclusion The effecacy and safety was similar between lower-dose peginterferon alfa-2b plus ribavirin and standard interferon alfa-2b plus ribavirin for treatment of chronic hepatitis C.