RESUMO
Objective To evaluate the application of modified MELD score based on the estimated glomerular filtration rate (eGFR) in the prognosis of patients with liver failure.Methods Clinical data of 558 patients with liver failure admitted in the First Affiliated Hospital of Xinjiang Medical University from December 2001 to September 2017 were retrospectively analyzed.Among all patients,238 cases survived (survival group) and 320 died (fatal group) within 3 months.The eGFR was used in the modified model for end stage liver disease (MELD) instead of serum creatinine.Cox regression analyses were fitted with modified MELD or MELD scores by SAS 9.0 PHREG.The receiver operating characteristic (ROC) curve was generated and the values of modified MELD score and MELD score in predicting the prognosis of patients with liver failure in 3 months were compared.Kaplan-Meier method was used to analyze the survival rate of patients with liver failure.Results Cox regression analysis showed that total bilirubin,international normalized ratio (INR) and eGFR were independent prognostic factors for patients with liver failure.The fitted MELD modified score =4.07 × ln total bilirubin (mg/dL) + 12.99 × ln INR-8.32 × ln eGFR.The area under the ROC curve (AUC) of the modified MELD score and the MELD score were 0.814 and 0.757,respectively,and the sensitivity and specificity of the modified MELD score were 70.0％ and 71.4％,respectively.The predictive power of modified MELD scores in patients with liver failure was better than MELD score (Z =4.47,P ＜ 0.01).The 3-month survival rate of patients with modified MELD score ＜-15.38 was significantly higher than those with modified MELD score ≥-15.38 (x2 =99.20,P ＜ 0.01).Conclusions eGFR is an independent risk factor for the prognosis of patients with liver failure.The modified MELD score including eGFR and excluding etiological factors can be more effective and more accurate for prognosis of patients with liver failure.
RESUMO
Objective To assess the prognostic value of APRI score and FIB-4 index for patients with chronic liver failure.Methods Clinical data of 426 patients with chronic liver failure admitted in the First Affiliated Hospital of Xinjiang Medical University from March 2005 to September 2014 were retrospectively analyzed.The MELD score,APRI score and FIB-4 index were calculated.Patients were divided into survival group and fatal group according to survival situation within 3 month after admission.Logistic regression was used to analyze the differences in all the indexes between the survival group and fatal group.Receiver operating characteristic (ROC) curve was used to assess the value of the above indexes in predicting the 3-month survival.Results Among 426 patients 244 died within three months after admission.Univariate analysis and multivariate Logistic regression showed that MELD score and FIB-4 index were statistically significant between the survival and fatal groups (Z =-4.783 and-4.104,x2 =26.31 and 11.34,both P ＜ 0.01).The area under the ROC curve of MELD score,APRI score and FIB-4 index was 0.635,0.511 and 0.616 for predicting 3-month survival,respectively.Compared with the APRI score,MELD score and FIB4 index were statistically different (x2 =13.669 and 6.341,P ＜ 0.05 or P ＜ 0.01).When MELD score ＞ 28,FIB-4 index ＞ 11.27,the patient has a high fatality rate and poor prognosis within three months.Conclusion FIB-4 index can be used to evaluate the short-term prognosis of patients with chronic liver failure,and the higher score of FIB-4 index predicts the worse prognosis.