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Application of a biochemical and clinical model to predict individual survival in patients with end-stage liver disease

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World Journal of Gastroenterology 2009年第22期15卷 2768-2777页

作者： Eduardo Vilar Gomez Luis Calzadilla Bertot bienvenido gra oramas Enrique Arus Soler Raimundo Llanio Navarro Javier Diaz Elias Oscar Villa Jiménez Maria del Rosario Abreu Vazquez Department of Hepatology National Institute of Gastroenterology Department of Pathology National Institute of Gastroenterology Department of Gastroenterology National Institute of Gastroenterology Deparment of Gastroenterology The"Calixto Garcia"Hospital Department of Biostatistics National Institute of Gastroenterology

AIM:To investigate the capability of a biochemical and clinical model,BioCliM,in predicting the survival of cirrhotic patients.METHODS:We prospectively evaluated the survival of 172 cirrhotic patients.The model was constructed using clinical(ascites,encephalopathy and variceal bleeding) and biochemical(serum creatinine and serum total bilirubin) variables that were selected from a Cox proportional hazards model.It was applied to estimate 12-,52-and 104-wk survival.The model's calibration using the Hosmer-Lemeshow statistic was computed at 104 wk in a validation dataset.Finally,the model's validity was tested among an independent set of 85 patients who were stratified into 2 risk groups(low risk≤8 and high risk>8).RESULTS:In the validation cohort,all measures of fi t,discrimination and calibration were improved when the biochemical and clinical model was used.The proposed model had better predictive values(c-statistic:0.90,0.91,0.91) than the Model for End-stage Liver Disease(MELD) and Child-Pugh(CP) scores for 12-,52-and 104-wk mortality,respectively.In addition,the Hosmer-Lemeshow(H-L) statistic revealed that the biochemical and clinical model(H-L,4.69) is better calibrated than MELD(H-L,17.06) and CP(H-L,14.23).There were no significant differences between the observed and expected survival curves in the stratified risk groups(low risk,P=0.61;high risk,P=0.77).CONCLUSION:Our data suggest that the proposed model is able to accurately predict survival in cirrhotic patients.

关键词：模型预测肝病末期患者临床生化应用

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