Komparacija prognostičkih skorova u odnosu na ishod kod pacijenata sa terminalnim stadijumom hroničnog oboljenja jetre

Abstract

Use of prognostic scores in assessment of disease severity has significantly facilitated understanding of prognosis in patients with terminal liver cirrhosis and made easier assessment of priorities on the waiting list of patients for the liver transplant. Initially applied scores, the Child-Turcotte-Pugh score and MELD score, showed some imperfections in practical implementation, so that, in time, the remodeled scores were created which purpose was, by adding relevant parameters for the disease, to achieve better prognostic value. In accordance with need to improve assessment of prognosis in terminal liver cirrhosis, the aim was set to examine new prognostic scores incurred by remodeling of the basic, CTP and MELD score. Relationship of the CTP crea I score, CTP crea II score, MELD Na score, MESO index, integrated MELD score, updated MELD score, UKELD score to complications of terminal liver cirrhosis has been examined. Results of the examinations showed that mortality risk in terminal liver cirrhosis is higher in patients with increasing CTP score, CTP crea II score, MELD score, MESO index and updated MELD score. The best characteristics in ROC analysis among the compared scores has the CTP crea II score (sensitivity 74%, specificity 74.1%, AUC=0.815, p<0.001). Increase of the MESO index for one unit also increases the mortality risk for 16%. The best predictor of one-month survival in patients with terminal liver cirrhosis is the CTP crea II score lower than 11.50. Six-month survival in terminal cirrhosis is depreciated by the MELD score lower than 18.50 and CTP crea score II lower than 11.50. By analyzing the relation of prognostic scores to presence of complications, a result has been obtained which confirms that in patients with more complications the CTP score class C is statistically significantly more frequent compared to patients who have one complication (χ2=7.88, p=0.005). The best indicators of one-month survival in patients with bleeding from esophageal varices are the CTP lower than 10.50, CTP cra I score lower than 10.50 and CTP crea II score lower than 11.50. Analyzing the predictivity of prognostic scores in relation to occurance of hepatorenal syndrom it was found that the best diagnostic marker of that condition is the integrated MELD score (sensitivity 80% and specificity 80,4%). Survival of patients with hepatorenal syndrom within the first, and then the first three of the sixth months after hospitalization, is better in patients who have the MELD score lower than 23.50 and MESO index lower than 18.50. Analysis of survival in patients with spontaneous bacterial peritonitis showed that mortality is more frequent in patients who have the CTP score higher than 10.50, CTP crea I score higher than 10.50 and CTP crea II score higher than 11.50. The best dignostic marker of the occurance of hepatic coma is the CTP score in ROC analysis, on the basis of the surface below the curve (AUC=0.913; p<0.001) and based on the highest sensitivity (82.6%) and specificity (82.8%). The best predictor of one-month, threemonth and six-month survival in patients with hepatic coma is the integrated MELD score lower than 40.50.