Ekindjian et al developed a prognostic score for patients with cirrhosis. They used discriminant analysis to compare clinical and laboratory findings in patients who survived with those who died. The authors are from the Hopital A. Chenevier in Creteil and the University of Paris in France.
Patients: All of the patients were adults, with most having alcoholic cirrhosis.
Parameters:
(1) total serum bilirubin
(2) encephalopathy
(3) Factor 5 level
(4) serum AST (SGOT)
(5) antithrombin III level
(6) transferrin
|
Parameter |
Finding |
Death Points |
|
total bilirubin |
> 55 µmol/L |
-1,796 |
|
|
<= 55 µmol/L |
699 |
|
encephalopathy |
present |
-343 |
|
|
absent |
443 |
|
Factor 5 levels |
> 27% |
255 |
|
|
<= 27% |
-660 |
|
serum AST |
> 43 IU/L |
-281 |
|
|
<= 43 IU/L |
269 |
|
antithrombin III level |
> 39% |
308 |
|
|
<= 39% |
-312 |
|
transferrin |
> 1.65 g/L |
452 |
|
|
<= 1.65 g/L |
-184 |
from Table 3, page 216
total death score =
= SUM(death points for all 6 parameters)
|
Parameter |
Finding |
Survival Points |
|
total bilirubin |
> 55 µmol/L |
688 |
|
|
<= 55 µmol/L |
-152 |
|
encephalopathy |
present |
199 |
|
|
absent |
-66 |
|
Factor 5 levels |
> 27% |
-3 |
|
|
<= 27% |
305 |
|
serum AST |
> 43 IU/L |
178 |
|
|
<= 43 IU/L |
-7 |
|
antithrombin III level |
> 39% |
-21 |
|
|
<= 39% |
188 |
|
transferrin |
> 1.65 g/L |
-69 |
|
|
<= 1.65 g/L |
145 |
from Table 3, page 216
total survival score =
= SUM(survival points for all 6 parameters)
Interpretation:
• The patient's prognosis is determined as the lesser of the two scores.
• If the death score > survival score, then the patient will probably survive.
• If the death score < survival score, then the patient will probably die.
Limitations:
• Current therapies have improved survival since the study was done in 1981. However, it can still identify patients with a worse prognosis.
Specialty: Gastroenterology
