Prognostic evaluation of patients with parenchymal cirrhosis. Proposal of a new simple score.
OBJECTIVE
The current shortage of organs makes it desirable to establish the prognosis of patients with cirrhosis in order to assess priority for liver transplantation.


METHODS
We compared the utility of two exogenous tests (aminopyrine breath test and lidocaine metabolization test), two clinical parameters (encephalopathy, ascites), 18 endogenous tests and five scores (Pugh, Merkel, Orrego, Adler, Pignon) for predicting 1-year mortality in patients with parenchymal cirrhosis. Retrospective (n=49 out of 63 patients) and prospective (n=38 out of 46 patients) series were included. Univariate, multivariate, receiver operator curves and survival curves were employed.


RESULTS
We found that endogenous tests were more discriminant than exogenous tests. The best parameters of the univariate analysis (encephalopathy, bilirubin, alkaline phosphatase, cholinesterase and bile acids) and their 25th and 75th percentiles were included in an additive new score which turned out to be superior to the five other scores. Prospectively, the sensitivity of our new score compared to the Pugh score was 82% versus 95% (NS) and the specificity was 89% versus 56% (p<0.01).


CONCLUSIONS
Our new simple score appears to be very powerful for predicting prognosis at 1 year for patients with cirrhosis and should be evaluated in other centers.
Adler
M
M
Medico-surgical Department of Gastroenterology and Hepato-Pancreatology, Hospital Erasme, Brussels, Belgium.
Verset
D
D
Bouhdid
H
H
Bourgeois
N
N
Gulbis
B
B
Le Moine
O
O
Van de Stadt
J
J
Gelin
M
M
Thiry
P
P
D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000378:metabolism; D001201:Ascites / Q000175:diagnosis / Q000209:etiology; D001663:Bilirubin / Q000378:metabolism; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality; D008111:Liver Function Tests / Q000379:methods; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D005723:gamma-Glutamyltransferase / Q000378:metabolism
D005723:gamma-Glutamyltransferase; D000469:Alkaline Phosphatase; D001663:Bilirubin