Establishment and evaluation of a predictive model for probability of death in patients with hepatitis B-related cirrhosis
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摘要: 目的 建立和验证预测乙肝后肝硬化患者死亡概率的数学模型,为肝硬化患者选择适宜的治疗方案及合理分配肝移植的肝源提供参考依据。方法 收集中南大学湘雅附属第一、二、三医院2000年11月—2012年11月收治的1 386例住院乙肝后肝硬化患者的临床记录和随访资料,应用logistic回归分析方法筛选变量建立患者入院后死亡预测数学模型,并运用受试工作者曲线(ROC)及儿童-特科特-pugh分级(CTP)评分、终末期肝病模型(MELD)评分比较其预测效率。结果 经多因素logistic回归分析,凝血酶原时间国际标准化比值(INR)、血清钠(Na)、总胆红素(TBIL)、血清肌酐(CRE)、脾厚度、上消化道出血和肝性脑病等7个指标进入回归方程,对乙肝后肝硬化患者死亡预测的敏感度为91.5%,特异度为92.4%,正确指数为0.839,阳性预测值为84.6%,阴性预测值为96.0%,阳性似然比为12.04,阴性似然比为0.09;患者入院3个月时CTP评分、MELD评分、logistic回归模型ROC的曲线下面积(AUG)及其95%CI分别为0.786(0.762~0.789)、0.825(0.794~0.864)、0.912(0.875~0.931),3种评分方法的AUG差异有统计学意义(Z=2.16,P=0.015)。结论 logistic回归模型能较好判断乙肝后肝硬化患者的短期存活或死亡概率,具有较强的诊断准确度和预后评估价值。Abstract: Objective To establish and evaluate a mathematical model for predicating the probability of death for patients with hepatitis B-related cirrhosis and to provide references for selecting reasonable therapeutic regimen.Methods Data on clinical manifestation and follow-up survey of 1 386 patients with hepatitis B-related cirrhosis were collected and analyzed retrospectively.Logistic regression analysis was adopted to construct a multiple regression equation for predicting the mortality probability of the patients after hospitalization treatment.Receiver operation curve(ROC),Child-Turcotte-Pugh(CTP),and the score based on the model for end-stage liver disease(MELD)were used to evaluate the efficiency of the prediction model established.Results Seven clinical indicators of the patients(international normalized ratio[INR],serum sodium content[Na],total bilirubin[TBIL],creatinine[CRE],spleen thickness,upper gastrointestinal bleeding,and hepatic encephalopathy)were included in the final multivariate regression equation.The established equation presents the sensitivity of 91.5%,specificity of 92.4%,correct index of 0.839,positive predictive value of 84.64%,negative predicative value of 96.0%,positive likelihood ratio of 12.04,and negative likelihood ratio of 0.09,respectively.For the utilization of CTP score,MELD score,and established regression model,the values of area under the ROC curve(95%confidence interval)were 0.786(0.762-0.789),0.825(0.794-0.864),and 0.912(0.875-0.931)for the prediction of death probability of the patients at the 3rd month of hospitalization,with significant difference among the three methods(Z=2.16,P=0.015).Conclusion A logistic equation was established with good sensitivity,specificity,and correct index for the prediction of death probability of patients with hepatitis B-related cirrhosis.
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Key words:
- hepatitis B-related cirrhosis /
- logistic regression model /
- MELD,CTP /
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