COX Regression Analysis Of Prognostic Factors In Decompensated Alcoholic Cirrhosis

Objective:To explore the prognostic factors of decompensated alcoholic cirrhosis,and to provide the basis for the prevention,treatment and prognosis of decompensated alcoholic cirrhosis.Methods:The clinical data of 213 patients with decompensated alcoholic cirrhosis who were admitted to Ganzhou People’s Hospital from January 1,2011 to December 31,2017 were col ected.A total of 179 patients were eventual y included based on inclusion and exclusion criteria,Sixteen clinical biochemical indexes including age,RDW,NLR,ALT,AST,TBA,ALP,Scr,BUN,PT,APTT,CHO,Na+,K+,CTP score and MELD score were col ected,which may affect the prognosis of decompensated alcoholic cirrhosis.With the confirmed decompensation period as the starting point and death as the end event,the 3-year and5-year prognosis of patients with alcoholic cirrhosis was tracked by telephone,outpatient and inpatient records system.The results were divided into survival group and death group.Statistical software was used for data analysis.Results:1.At 3-year fol ow-up,patients with decompensated alcoholic cirrhosis were divided into survival group and death group,with 148 cases in survival group and 31 cases in death group.There were no significant differences in the indexes of ALT,ALP,Scr,BUN,CHO,Na+and K+ between survival group and death group(P>0.05).Age,RDW,NLR,AST,TBA,PT,APTT,CTP score and MELD score in death group were significantly higher than those in survival group(P<0.05).2.At 5-year fol ow-up,patients with decompensated alcoholic cirrhosis were divided into survival group and death group,with 127 cases in survival group and 52 cases in death group.There were no significant differences in the indexes of ALT,ALP,Scr,BUN,CHO,Na+and K+ between survival group and death group(P>0.05).Age,RDW,NLR,AST,TBA,PT,APTT,CTP score and MELD score in death group were significantly higher than those in survival group(P<0.05).3.In univariate COX regression analysis,RDW,NLR,TBA,PT,APTT,CTP score and MELD score were the influencing factors of 3-year death in decompensated alcoholic cirrhosis.Age,RDW,NLR,TBA,PT,APTT,CTP score and MELD score were the influencing factors of 5-year death in decompensated alcoholic cirrhosis.4.Through multivariate COX regression analysis,RDW,NLR,CTP score and MELD score were independent risk factors for 3-year and 5-year death in patients with decompensated alcoholic cirrhosis.5.The 3-year survival rate of patients with NLR>11.19,RDW>16.6%,CTP>9.5 and MELD>7.5 decreased significantly,and the difference was statistical y significant(P<0.001).The 5-year survival rate of patients with NLR>8.93,RDW>14.65%,CTP>9.5 and MELD>7.5decreased significantly,and the difference was statistically significant(P<0.001).6.ROC curve analysis of all indexes and combined indexes to evaluate the prognostic effect showed that the AUCs of RDW,NLR,CTP score and MELD score for predicting 3-year death in patients with decompensated alcoholic cirrhosis were 0.773,0.812,0.838 and0.809,respectively.The sensitivity and specificity were(0.645,0.878),(0.677,0.946),(0.710,0.804),(0.839,0.703),respectively.The AUCs for predicting 5-year death in decompensated alcoholic cirrhosis were 0.814,0.820,0.783,0.811,and the sensitivity and specificity were(0.808,0.772),(0.692,0.890),(0.596,0.858),(0.885,0.685),respectively.It indicated that al the indicators were valuable in the evaluation of prognosis(see Table 3 and Figure 1).The combination of the four indexes in pairs,in combination with the three indexes and in combination with all of them showed that the AUC of the four indexes combined to predict the 3-year death of the patient was 0.928,the sensitivity and specificity were 0.827 and0.913,and the AUC of the patients combined to predict the 5-year death of the patient was0.939,the sensitivity and specificity were 0.827 and 0.906.Conclusion:1.RDW,NLR,CTP score and MELD score are independent risk factors for prognosis of patients with decompensated alcoholic cirrhosis.2.The combined use of RDW,NLR,CTP and MELD scores is more effective in predicting the prognosis of patients with decompensated alcoholic cirrhosis than using a single index.