Objective To investigate the value of Glasgow-Blatchford score (GBS),Child-Turcotte-Pugh (CTP) score,and Model for End-Stage Liver Disease (MELD) score in predicting the 1-and 6-week prognosis of cirrhotic patients with esophagogastric variceal bleeding via a comparative analysis.Methods A retrospective analysis was performed for the clinical data of 202 cirrhotic patients with esophagogastric variceal bleeding who were hospitalized in Tianjin Third Central Hospital from January 1 to December 31,2014.According to the endpoint of death at 6 weeks after admission,the patients were divided into 1-week death group (10 patients),6-week death group (23 patients),and survival group (179 patients).The Glasgow-Blatchford score,MELD score,CTP score,and CTP score and classification were calculated on admission,and these scores were compared between the three groups.The two-independent-samples t test was used for comparison of normally distributed continuous data between groups,and the non-parametric Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups.The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups.The Z test was used for comparison of the area under the receiver operating characteristic curve (AUC) of these three scoring systems.Results There were significant differences between the 1-week death group and the survival group in the incidence rates of liver cancer with vascular invasion or metastasis (x2 =4.559,P =0.033),hepatic encephalopathy (x2 =25.568,P ＜ 0.01),melena (x2 =0.842,P =0.04),and heart failure (P =0.003),pulse rate (Z =-2.943,P =0.003),CTP classification (x2 =12.22,P =0.002),CTP score (Z =-2.505,P =0.012),MELD score (t =-2.395,P =0.018),and GBS score (Z =-2.545,P =0.011).There were significant differences between the 6-week death group and the survival group in the incidence rates of liver cancer (x2 =9.374,P =0.002),liver cancer with vascular invasion or metastasis (x2 =14.766,P ＜ 0.01),and hepatic encephalopathy (x2 =16.327,P ＜0.01),albumin (Z =-2.770,P =0.006),bilirubin (Z =-3.191,P =0.001),hemoglobin (Z =-2.484,P =0.013),blood urea nitrogen (Z =-2.407,P =0.016),international normalized ratio (Z =-2.304,P =0.021),systolic pressure (t =2.69,P =0.008),pulse rate (Z =-3.507,P ＜ 0.01),CTP classification (x2 =25.851,P ＜ 0.01),CTP score (Z =-3.591,P＜0.01),MELD score (t =-4.121,P＜0.01),and GBS score (Z=-3.54,P＜0.01).GBS score (AUC =0.738,95％ confidence interval [CI]:0.67-0.80) was superior to MELD score (AUC =0.731,95％ CI:0.66-0.79) and CTP score (AUC =0.728,95％ CI:0.66-0.79) in predicting the risk of death at 1 week.MELD score (AUC =0.761,95％ CI:0.70-0.89) was superior to CTP score (AUC =0.748,95％ CI:0.69-0.81) and MELD score (AUC =0.726,95％ CI:0.66-0.79) in predicting the risk of death at 6 weeks.There was a significant difference in the AUC for predicting the death rate at 1 week between GBS score and CTP score (Z =0.079,P =0.037),while there was no significant difference in the AUC for predicting the death rate at 6 weeks between the three scoring systems (P ＞ 0.05).Conclusion GBS score is superior to MELD score and CTP score in predicting the risk of death at 1 week in cirrhotic patients with esophagogastric variceal bleeding,and MELD and CTP scores are superior to GBS score in predicting the risk of death at 6 weeks.%目的 比较Glasgow-Blatchford评分(GBS评分)、Child-Pugh评分(CTP评分)和终末期肝病模型(MELD)评分对预测肝硬化伴食管胃底静脉曲张破裂出血1周和6周预后的价值.方法 回顾性收集自2014年1月1日-2014年12月31日在天津市第三中心医院住院的202例肝硬化伴食管胃底静脉曲张出血患者的病历资料.以入院后6周的最后结局死亡为研究终点,分为1周内死亡组(n=10)、6周内(包含1周)死亡组(n=23)、存活组(n=179).分别计算其入院时的GBS评分、MELD评分和CTP评分及分级,比较各评分系统在1周内或6周内死亡组和生存组的差异.符合正态分布的计量资料组间比较采用两独立样本t检验,不符合正态分布的采用Mann-Whitney U检验.计数资料组间比较采用x2检验或Fisher检验.各评分系统之间受试者工作特征曲线下面积(AUC)的比较采用Z检验.结果 1周内死亡组与生存组相比,肝癌伴血管侵犯或转移(x2=4.559,P=0.033)、肝性脑病(x2=25.568,P＜0.01)、黑便(x2=0.842,P=0.04)、心力衰竭发生率(P=0.003)、脉搏(Z=-2.943,P=0.003),以及CTP分级(x2=12.22,P=0.002)、CTP评分(Z=-2.505,P=0.012)、MELD评分(t=-2.395,P=0.018)、GBS评分(Z=-2.545,P=0.011)差异均有统计学意义;6周内死亡组与生存组相比,肝癌(x2=9.374,P=0.002)、肝癌伴血管侵犯或转移(x2=14.766,P＜0.01)、肝性脑病发生率(x2=16.327,P＜0.01),Alb(Z=-2.770,P=0.006)、胆红素(Z=-3.191,P=0.001)、Hb(Z=-2.484,P=0.013)、血尿素氮(Z=-2.407,P=0.016)、INR(Z=-2.304,P=0.021)、收缩压(t=2.69,P=0.008)、脉搏(Z=-3.507,P＜0.01)水平,以及CTP分级(x2=25.851,P＜0.01)、CTP评分(Z=-3.591,P＜0.01)、MELD评分(t=-4.121,P＜0.01)、GBS评分(Z=-3.54,P＜0.01)差异均有统计学意义.预测1周死亡风险,GBS评分[AUC=0.738,95％可信区间(95％CI):0.67～0.80]优于MELD评分(AUC=0.731,95％ CI:0.66 ～0.79)及CTP评分[AUC =0.728,95％CI:0.66 ～0.79)].预测6周死亡风险,MELD评分(AUC =0.761,95％ CI:0.70 ～0.89)优于CTP评分(AUC=0.748,95％CI:0.69～0.81)及GBS评分(AUC=0.726,95％CI:0.66～0.79).3种评分系统之间预测1周病死率AUC的比较,GBS评分与CTP评分之间差异有统计学意义(Z =0.079,P=0.037),余各评分系统之间以及3种评分系统预测6周病死率比较,差异均无统计学意义(P值均＞0.05).结论 对于肝硬化伴食管胃底静脉曲张破裂出血患者1周死亡风险的预测方面,GBS评分优于MELD评分及CTP评分,6周死亡风险的预测方面,MELD及CTP评分优于GBS评分.
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