| Objective: To analyze the prognostic factor and develop a prognostic model for patients with chronic severe hepatitis(CSH). Methods: We retrospectively collected the hospital files of 385 in patients from December, 1998 to October, 2003 for the treatment of chronic severe hepatitis in center for infectious disease, south-west hospital. Survival was estimated with the method of Kaplan-Meier, and associated clinical and laboratory variables were studied in univariate and multivariate Cox model-based analyses. Results: Follow-up was completed in February, 2004. 274 died (71.2%) ,47 were alive(12.2%), 54 (14.3%) were lost to follow up and 9(2.3%) were censored .The median Follow-up time was 2.6 months(range 0.03 to 62 months). Median survival time of this study group was 1.6 months. The survival rates, calculated with the Kaplan-Meier method, was estimated as 66.2%, 32.9%, 26.9% at 1, 3, 6 months respectively, 22.9 % at 1-year, and 17.7% at 3 years. Four prognostic factors were extracted using Cox's proportional hazard model; the prognostic index was calculated using the following formula consisting of these factors. MCSH(model of chronic severe haptitis,MSCH)=0.016×Age + 1.148×hepatic encephalopathy+0.294×loge(bilirubin μmol/L)-0.826×loge (prothrombin time activity). The prognostic model was validated in an independent series of 80 patients with CSH admitted to south-west hospital from November, 2003 to June, 2004. This model shows sensitivity of 88.1%, specificity of 81% and an overall predictive accuracy of 85% in predict 3-month survival.The area under the receiver operating characteristic (ROC) curve for this prognostic model was 0.92 compared with 0.81 for the MELD(model of end stage liver disease) score (P < 0.001). Conclusion: A model using four parameters can accurately predict 3 month mortality in patients with chornic severe hepatitis and is better than MELD. This modle may be useful to guide clinicians in selection of treatment method for CSH. |
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