内科

目的分析肝硬化伴急性上消化道出血的死亡相关因素，并探讨终末期肝病模型（MELD）评分、白蛋白-胆红素（ALBI）评分、格拉斯哥-布拉奇福德评分（GBS）、急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）四种预后评分系统预测肝硬化伴急性上消化道出血患者预后的价值。方法回顾性分析71例肝硬化伴急性上消化道出血患者的临床资料，根据患者是否院内死亡分为死亡组（6例）和生存组（65例）。比较两组患者的基线资料（包括性别、年龄、合并症等）和MELD评分、ALBI评分、GBS、APACHE Ⅱ评分。依据MELD评分、ALBI评分、GBS、APACHE Ⅱ四种预后评分系统标准对患者进行评分，绘制受试者操作特征（ROC）曲线，并计算曲线下面积（AUC）以评价各评分系统预测肝硬化伴急性上消化道出血患者预后的效果。结果死亡组患者存在合并症、意识改变占比均高于生存组，收缩压低于生存组，脉搏、血肌酐水平、总胆红素水平、凝血酶原时间、MELD评分、ALBI评分、GBS、APACHE Ⅱ评分均高或长于生存组（均P＜0.05）。 MELD评分、ALBI评分、GBS、APACHE Ⅱ预测肝硬化伴急性上消化道出血患者预后的AUC分别为0.856（95%CI：0.719~0.994），0.762（95%CI：0.501~1.000），0.831（95%CI：0.690~0.971），0.874（95%CI：0.766~0.983）。结论意识改变、血压低、脉搏增快、存在合并症、凝血酶原时间延长、血肌酐水平升高、总胆红素水平升高可能与肝硬化伴急性上消化道出血患者死亡相关，MELD评分、ALBI评分、GBS、APACHE Ⅱ预测肝硬化伴急性上消化道出血患者预后均有一定的价值。

ObjectiveTo analyze the death-related risk factors of liver cirrhosis with acute upper gastrointestinal bleeding and explore the value of four prognostic scoring systems, model for end-stage liver disease (MELD) score, albumin-bilirubin (ALBI) score, Glasgow-Blachford score (GBS), and Acute Physiology and Chronic Health Evaluation II(APACHE II), in predicting the prognosis of patients with liver cirrhosis and acute upper gastrointestinal bleeding. MethodThe clinical data of 71 patients with liver cirrhosis and acute upper gastrointestinal bleeding were retrospectively analyzed, and the patients were divided into a death group (6 cases) or a survival group (65 cases) according to whether they died in the hospital. The baseline data (including gender, age, comorbidities, etc.), MELD score, ALBI score, GBS, and APACHE II score of the two groups were compared. The patients were scored according to the four prognostic scoring systems′ criteria, including MELD score, ALBI score, GBS, and APACHE II. The receiver operating characteristics (ROC) curve was drawn, and the area under the curve (AUC) was calculated to evaluate the effect of each scoring system in predicting the prognosis of patients with liver cirrhosis and acute upper gastrointestinal bleeding. ResultsThe proportions of patients with comorbidities and altered consciousness were higher; the systolic blood pressure was lower, and the pulse, blood creatinine level, total bilirubin level, prothrombin time, MELD score, ALBI score, GBS,and APACHE II score were higher or longer in the death group than in the survival group (all P＜0.05). The AUCs of MELD score, ALBI score, GBS, and APACHE II in predicting the prognosis of patients with liver cirrhosis and acute upper gastrointestinal bleeding were 0.856 (95% CI: 0.719~0.994), 0.762 (95% CI: 0.501~1.000), 0.831 (95% CI: 0.690~0.971), and 0.874 (95% CI: 0.766~0.983), respectively. ConclusionAltered consciousness, low blood pressure, rapid pulse, comorbidity, prolonged prothrombin time, and elevated blood creatinine and total bilirubin levels may be related to death in patients with liver cirrhosis and acute upper gastrointestinal bleeding; MELD score, ALBI score, GBS, and APACHE II have certain value in predicting the prognosis of patients with liver cirrhosis and acute upper gastrointestinal bleeding.