Application Value Of Different Liver Function Scores In Predicting The Prognosis Of ERCP In Patients With Liver Cirrhosis And Common Bile Duct Stones

Objective: To study the relationship between two liver function scoring methods（Child-Pugh score and MELD score）and the incidence of adverse events in patients with liver cirrhosis complicated with choledocholithiasis after ERCP,and to explore the effectiveness of the two scoring methods in predicting different postoperative outcomes.Methods: From January 2012 to January 2019,the clinical data of all patients with liver cirrhosis who underwent ERCP for common bile duct stones were collected.Based on all the clinical data of patients before,during and after operation,the patients were divided into two groups according to two kinds of liver function scores,and the differences of clinical outcomes among the groups were compared respectively.The clinical data after operation were used to evaluate the accuracy of two liver function scoring systems in predicting various outcomes of patients after operation.Chi-square test or Fisher exact test were used to screen out the specific postoperative outcomes that can be accurately predicted by the two liver function scores.Receiver operating characteristic curve（ROC）is then used to evaluate which of the two scoring systems is more accurate in predicting specific outcomes.Univariate chi square test and multivariate binary logistic regression analysis were used to screen the independent risk factors of perioperative bleeding.Results:1.Baseline information:According to the exclusion criteria,109 patients were included in this study,with an average age of 57.63±14.64 years,of which the average age of males was55.5±15.65 years and that of females was 60.0±13.20 years.The average hospital stay was 12.77±10.30 days,and the ratio of male to female patients was 57: 52.Among the109 patients,34 cases（31.2%）were of Child A grade,57 cases（52.3%）were of Child B grade and 18 cases（16.5%）were of Child C grade.The mean MELD score was13.98 5.86,among which the mean MELD score of Child A patients was 9.09 1.91,that of Child B patients was 14.47 4.04 and that of Child C patients was 21.67 5.71.There is a positive correlation between the two liver function scores,but there is no statistical significance between them.2.The relationship between two liver function scores and different postoperative outcomes.（1）Utilization rate of blood products: With the increase of liver function score,the utilization rate of blood products also increased.The Child Score（AUC =0.77995% CI = 0.674-0.883）and MELD score（AUC = 0.76895% CI = 0.655-0.882）were analyzed by ROC curve.（2）Perioperative bleeding rate: The rate of perioperative bleeding increased with the deterioration of liver function.The risk factors of perioperative bleeding were Child grade,MELD score,intraoperative papillary dilatation,AST level,ALB level and TB level in single factor analysis by chi-square test,the independent risk factors for perioperative bleeding were Child grade C,high MELD score and no intraoperative papillary muscle dilatation.Two scoring methods were used to predict the outcome: Child Grade（AUC = 0.80895% CI = 0.690-0.926）and Meld score（AUC = 0.80395% CI = 0.682-0.963）.（3）Complications of CDCIV grade: With the deterioration of liver function,the probability of postoperative outcome of patients with stage IV complications of CDC also increased.The results of ROC curve analysis of two liver function scoring methods were Child grade（AUC = 0.81995% CI = 0.691-0.947）,m ELD score（AUC= 0.84895% CI = 0.722-0.974）.The MELD score was 0.657,and the Meld cut-off score was 14.5.When the MELD score was greater than or equal to 14.5,the prediction of Grade IV complications was more accurate.（4）Death outcome: A total of 7 patients with CDCV（death）were included in this study.The Child Score（AUC = 0.84195% CI = 0.704-0.978）was assessed by ROC curve,m ELD score（AUC = 0.72195% CI = 0.540-0.903）.Conclusion: Child grade C,MELD score and no papillary sphincter dilatation were independent risk factors for perioperative bleeding risk in patients with liver cirrhosis complicated with common bile duct stones undergoing ERCP.MELD score has advantages in predicting the incidence of postoperative grade IV complications and total postoperative complications;Child classification has more advantages in predicting perioperative bleeding,death outcome and utilization rate of blood products.