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Titolo:
Major clinical events, signs and severity assessment scores related to actual survival in patients who died from primary biliary cirrhosis. A long-term historical cohort study
Autore:
van Dam, GM; Gips, CH; Reisman, Y; Maas, KW; Purmer, IM; Huizenga, JR; Verbaan, BW;
Indirizzi:
Statengen, Groningen, Fac Med Sci, Int Sch Hepatol & Trop Med GISH T, Groni State Univ Groningen Groningen Netherlands tol & Trop Med GISH T, Groni Acadgen,p Groningen, Dept Internal Med, Div Gastroenterol & Hepatol, Gronin Acad Hosp Groningen Groningen Netherlands stroenterol & Hepatol, Gronin
Titolo Testata:
HEPATO-GASTROENTEROLOGY
fascicolo: 25, volume: 46, anno: 1999,
pagine: 108 - 115
SICI:
0172-6390(199901/02)46:25<108:MCESAS>2.0.ZU;2-B
Fonte:
ISI
Lingua:
ENG
Soggetto:
LIVER-TRANSPLANTATION; PROGNOSTIC IMPORTANCE; PUGH-CHILD; MODEL; PREDICTION; NETHERLANDS; RISK; PBC;
Keywords:
primary biliary cirrhosis; Mayo model; Child-Campbell; Pugh-Child; ascites, nutritional state; prognostic models;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
30
Recensione:
Indirizzi per estratti:
Indirizzo: van Dam, GM Univen,oningen Hosp, Dept Surg, Hanzeplein 1,POB 30-001, NL-9700 RB Groning Univ Groningen Hosp Hanzeplein 1,POB 30-001 Groningen Netherlands NL-9700 RB
Citazione:
G.M. van Dam et al., "Major clinical events, signs and severity assessment scores related to actual survival in patients who died from primary biliary cirrhosis. A long-term historical cohort study", HEP-GASTRO, 46(25), 1999, pp. 108-115

Abstract

BACKGROUND/AIMS: One of the prognostic methods for survival in primary biliary cirrhosis (PBC) is the Mayo model, with a time-scale limited to 7 years. The aim of our study was to assess how major clinical events, signs, several severity assessment methods and Mayo survival probabilities fit in with actual patient survival, by using yearly observations until 0.5 years before patient death from PBC. METHODOLOGY: Data of 32 patients dying from PBC were collected prior to death at -0.5, -1, -2 etc. years (median: -5 years, range: -16 to -0.5 years). Major events registered were: first occurrence of ascites, upper gastrointestinal bleeding or manifest hepatic encephalopathy and signs, first observation of spider naevi or purpura. Severity assessment methods applied (allwith scores and classes) were: Mayo (M), Child-Campbell (C), Pugh-Child (P), Pugh-Child-PBC (PP), 'Child-Pugh' (CP), and Ascites Nutritional State-Child (ANS). Fifty percent survival estimates were calculated from Mayo scores. Severity assessment method variables were: ascites (C, P, PP, CP, ANS), encephalopathy (C, P, PP, CP), nutritional state (C, ANS), edema (M), age (M), serum albumin (M, C, P, PP, CP), bilirubin (C, M, P, PP, CP), and prothrombin time (M, P, PP, CP). RESULTS: In 27 out of 32 patients a major event occurred, always between -6 and -0.5 years (median: -1 year) and, never between -16 and -7 years (p<0.0001). A sign was first observed in 30/32 between -14 and -0.5 years (median: -2 years). Compared to the total population, a sign, and even more so, an event indicated a shorter survival (p=0.004 and p=0.0002, respectively). The median 50% estimated survival (predicted by the Mayo model) fitted theactual survival from -6 to -0.5 years (r=-0.7, p<0.0001), but not from -16to -7 years (r=-0.1, p=0.4). All -6 to -0.5-year severity scores correlated (p<0.0001) both with actual survival (M, C, P, PP and CP r=0.7; ANS r=0.5) and with estimated M 50% survival (C, P, PP, CP r=-0.9; ANS r=-0.6; M score: -0.99), but none with actual survival from -16 to -7 years, except for M, slightly (r=-0.3, p=0.04). A nomogram for mean C, CP, M and ANS scores related to actual survival was constructed for the -6 to -0.5-year period. The C and CP classes A, B, and C did not appear to distinguish sufficiently into actual survival, whereas the M classes did. CONCLUSIONS: The occurrence of a major event appeared to exclude survival over 6 years. In these final 6 years, Child-Campbell, Mayo and Pugh scores correlated equally well with actual survival and better than Ascites/Nutritional State score. In our PBC patients, Campbell was an excellent alternative for Pugh; for Pugh, the original Child-Turcotte variable limits were fully sufficient.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 28/11/20 alle ore 21:20:34