The Research Of Decompensated Cirrhosis Prognostic Risk Factors And Comparison Of Prognostic Models

【Objective】Research the prognostic risk factors of decompensated cirrhosis. Compare thePredictive value of Child-Pugh classification, terminal end-stage liver disease model(MELD) score, MELD-Na score and Cr-Child score. Help clinicians determine theprognosis outcome of patients with decompensated cirrhosis accurately and have importantvalue to choose effective treatment clinically.【Methods】1. From January2010to December2013,231patients hospitalized withdecompensated cirrhosis, Gastroenterology of Second Affiliated Hospital of SuzhouUniversity were chosen. Retrospective analysis was applied in studying the clinical case,design history information registration form, record the basic situation including medicalhistory, laboratory tests and imaging information of each case study, using telephonefollow-up approach and recorded three mouths events ending of every study patients. Thedata input as a database was used by Microsoft Excel2007for Windows, using SPSS17.0for windows for statistical analysis. T test and rank test was used on quantitative data, chi-square test was used on qualitative data. Multivariate Logistic analysis Was used toanalysis of independent risk factors.2. Select the method of comparative clinical data as Child-Pugh classification, MELDscore, MELD-Na score, Cr-Child rated analyze samples of these four prognostic model.Calculating the area under the receiver operating characteristic curve (ROC) curve of(AUC) for comparing their predictive value. 【Results】1. Univariate Logistic analysis showed that upper gastrointestinal bleeding, WBC,ALB, Cys C, HDL, Na, A/G were prognostic factors. Upper gastrointestinal bleeding, CysC, risk of death in patients with a positive correlation (P <0.05), WBC, ALB, HDL, Na, A/G risk of death in patients with a negative correlation (P <0.05), the rest showed nostatistical significance (P>0.05).2. Multivariate Logistic analysis showed that Serum albumin and sodium were theindependent risk factors for prognosis of decompensated cirrhosis. The area under theROC curve (AUC) of the risk factors, Serum albumin and sodium were0.867and0.904,compared with the0.5difference was statistically significant (P <0.001).3. The area under the ROC curve (AUC) of the prognostic model, MELD-Na, MELD,Child-Pugh and Cr-Child Model were0.812(95%CI0.715-0.909),0.802(95%CI0.703-0.901),0.783(95%CI0.618-0.885) and0.732(95%CI0.621-0.843), The rest showed nostatistical significance (P>0.05). The MELD-Na score to predict prognosis of decompensatedcirrhosis patients was superior to Child-Pugh, MELD and Cr-Child.【Conclusion】Serum albumin and sodium were independent risk factors for the short-term prognosisin decompensated cirrhosis, the serum sodium level has a higher predictive value forprognosis. Predictive value of MELD-Na score is better than Child-Pugh, MELD, Cr-Child,which has the advantage of objectivity, stability, worthy of widespread use.