The Value Of MELD Score And Serum High-density Lipoprotein Cholesterol In Predicting The Prognosis Of Patients With Cirrhosis And Portal Vein Thrombosis

BackgroundLiver cirrhosis is one of the most common chronic progressive liver disease in China,which can be accompanied by various clinical complications.Among then,Portal vein thrombosis(PVT),a kind of thrombus that could grows in the main portal vein and its branches,is also one of the most important risk factors accounting for the prognosis of liver cirrhosis patients.At present,Child-Pugh score and end-stage liver disease model(Model for End-stage liver disease,MELD)are widely used to evaluate the severity of liver insufficiency and predict the prognosis of patients with end-stage liver disease.Liver is an important organ of lipid anabolism and catabolism.Previous studies have shown that high density lipoprotein cholesterol(HDL-C)is related to the level of liver function.Adding a new scoring standard to the MELD scoring model can significantly improve the ability to predict the prognosis of patients with end-stage liver cirrhosis.The accuracy of MELD scoring model combined with HDL-C level in the prognosis of cirrhotic patients complicated with PVT still needs to be observed in a large number of clinical trials.Objectives1.To compare the value of MELD scoring model,Child-Pugh score and blood lipid profile in predicting one-year mortality rate of patients with liver cirrhosis complicated with PVT.2.To explore the predictive effect of MELD score combined with HDL-C level on one-year mortality in patients with liver cirrhosis complicated with PVT.Materials and methodsFrom January 2015 to July 2018,patients with liver cirrhosis complicated with PVT admitted to Nanfang Hospital of Southern Medical University were collected retrospectively.The cases that meet the criteria were screened out according to the inclusion and exclusion criteria.The clinical records,imaging results and laboratory data of these cases were summarized.The one-year survival rate of the patients are collected according to the follow-up progress.The clinical data of survival group and death group within one year were collated and analyzed.To study the correlation between blood lipid profile and liver function index,Child-Pugh score and MELD score,univariate and multivariate analysis of clinical data were performed by IBM SPSS 22.0 software,and the receiver working characteristic curve(ROC)was drawn to evaluate the predictive effect of MELD score,Child-Pugh score and HDL-C level on one-year mortality in patients with liver cirrhosis complicated with PVT according to the area under the working characteristic curve(AUROC).Using the cut-off value of ROC curve to establish Kaplan-Meier survival curve,and analyze the prognostic value of MELD score combined with high density lipoprotein cholesterol in patients with liver cirrhosis complicated with PVT.ResultsA total of 118 cases were included in this study,and 17 patients died during the follow-up period,with a case fatality rate of 14.41%within one year.Comparison of clinical data between the death group and the survival group during the one-year follow-up:(1)The Child-Pugh grade and the MELD score of the death group were higher than those of the survival group,and there were significant differences between the two groups(p<0.001),the level of total bilirubin in the death group was significantly higher than that of the survival group,while the level of HDL-C was lower than that of the survival group,and there were significant differences between the two groups(p<0.001).The values of INR and CRP in the death group were higher than those in the survival group,and the differences between them were statistically significant(p<0.01).(2)The MELD scoring model was divided into three groups:MELD?10,11 ? MELD ?20 and MELD? 21,and the differences between the survival group and the death group during the one-year follow-up were compared.The results showed that the chi-square ?2=20.29,p<0.001,and with the increase of the MELD score,the mortality rate of the patients increased significantly,the mortality rates of the three groups were 2.0%,20.6%and 75.0%respectively.In addition,the differences between the survival group and the death group during the one-year follow-up period of group A,B and C were compared.The results showed that the chi-square ?2=21.87(p<0.001).And with the increase of Child-Pugh score,the mortality rate of the three groups increased gradually,the mortality rates of the three groups were 3.7%,11.4%and 58.3%respectively.(3)There were significant differences in the levels of total cholesterol,HDL-C and LDL-C among the three MELD groups and the Child-Pugh groups(p<0.01).The results showed that there were significant differences in the levels of total cholesterol,HDL-C and LDL-C among the three groups except triglycerides.(4)The correlation analysis between various liver function indexes and the level of lipid spectrum showed that there was a strong negative correlation between MELD score,Child-Pugh grade,total bilirubin and CRP and HDL-C(correlation coefficient R=-0.387,-0.589,-0.505,-0.434 respectively,p<0.001).(5)In the binary Logistic regression model,after adjusting the confounding factors such as sex,age and liver function index,the risk of death within one year in the patients with HDL-C<0.57 was significantly higher than that in the control group(OR=14.187,95%CI:4.252-49.054,p<0.001).In multivariate Logistic regression analysis,Child-Pugh score(OR=3.13,95%CI:1.20-8.17,p<0.01),MELD(OR=1.167,95%CI:1.015-1.328,p<0.05)and HDL-C(OR=9.516,95%CI:3.609-39.523,p<0.001)could be used as independent risk factors for mortality within one year.(6)The diagnostic accuracy of MELD score,Child-Pugh score and HDL-C level for the prognosis of patients within one year was valuable,and the areas under the ROC curve were 0.812,0.866 and 0.932 respectively.Kaplan-Meier survival curve showed that MELD score,Child-Pugh grade and HDL-C level could better evaluate the prognosis of patients with liver cirrhosis complicated with PVT.ConclusionsMELD score,Child-Pugh score and HDL-C level have reliable accuracy in predicting the prognosis of patients within one-year.Yet HDL-C level will not completely replace MELD score or Child-Pugh score.In order to further improve the accuracy of diagnosis,the combination of MELD score and HDL-C level can better predict the one-year prognosis of patients with liver cirrhosis complicated with PVT.