Since renal failure, malnutrition and alcohol use can affect outcome in patients with cirrhosis, it was hoped that a combination of these factors with the Child-Pugh score would provide a more accurate prognostic assessment in patients with advanced nonbleeding cirrhosis.
Patient Selection:
(1) Cirrhotics without gastrointestinal bleeding.
(2) Patients with hemochromatosis, hepatoma or biliary cirrhosis were excluded.
Variables associated with prognosis in univariate analysis:
(1) triceps skinfold thickness
(2) mid-arm muscle circumference
(3) serum urea
(4) serum sodium
(5) red blood cell MCV
prognostic index =
= (0.302 * (Child-Pugh score)) + (0.113 * (serum urea in mmol/L)) + (0.027 * (MCV in femtoliters) - (0.025 * (mid arm muscle circumference as a percent of the 50th percentile of the healthy population))
where:
• Child-Pugh score ranges from 5 (good) to 15 (bad)
• conversion factor for serum urea nitrogen mg/dL to mmol/L is 0.357
• MCV in the paper is given in µ^3. 1 µ = 10^(-6) meters. 1 liter = 10^(-3) cubic meters. 1 femtoliter = 10^(-15) liters = 10^(-18) cubic meters.
• MCV is somewhat associated with recent alcohol intake.
• mid-arm muscle circumference in cm = (mid arm circumference in cm) - ( π * (triceps skin-fold thickness in cm))
• The 50th percentile of the mid-arm muscle circumference is determined in a healthy reference population.
Interpretation
|
PI value |
1 year survival |
2 year survival |
|
1.0 |
100 |
100 |
|
1.5 |
98 |
96 |
|
2.0 |
96 |
92 |
|
2.5 |
92 |
90 |
|
3.0 |
90 |
84 |
|
3.5 |
84 |
75 |
|
4.0 |
75 |
60 |
|
4.5 |
60 |
45 |
|
5.0 |
45 |
27 |
|
5.5 |
25 |
12 |
|
6.0 |
12 |
5 |
|
6.5 |
5 |
0 |
|
7.0 |
0 |
0 |
|
7.5 |
0 |
0 |
|
8.0 |
0 |
0 |
approximated from curves c and d, Figure 2, page 385.
Specialty: Gastroenterology
