To Explore The Predictive Value Of Child-Pugh Grade And MELD Score In The Diagnosis Of Hepatitis B Cirrhosis Complicated With Cirrhotic Cardiomyopathy

Objective: To explore the predictive value of Child-Pugh grade and MELD score in the diagnosis of hepatitis B cirrhosis complicated with cirrhotic cardiomyopathy.Methods: A case-control study was conducted in strict accordance with the inclusion and exclusion criteria of cases and controls.Forty-five patients with hepatitis B cirrhosis complicated with CCM who were hospitalized in Mengchao hepatobiliary Hospital of Fujian Medical University from February 2015 to July 2018 were randomly selected as the case group.One hundred patients with hepatitis B cirrhosis without CCM in the same period were selected as control.Collect general data: sex,age;Auxiliary examination: blood routine examination [white blood cell count(WBC),platelet count(PLT),hemoglobin(Hb)],coagulation function [prothrombin time(PT),prothrombin activity(PTA)],liver function Child-Pugh grade(grade A,B,C),liver function index [alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),Albumin(ALB)],creatine kinase isoenzyme(CKMB),creatinine(Cr),MELD score {end-stage liver disease model,Rat3.8 ln [bilirubin(mg/dl)] + 11.2ln(INR)+ 9.6ln [creatinine(mg/dl)] + 6.4},ascites,liver color ultrasound(portal vein diameter),ECG [heart rate(HR)],cardiac color ultrasound [left atrial diameter(LAD),left ventricular end-diastolic diameter(LVDd),left ventricular end-systolic diameter(LVDs),left ventricular ejection fraction(LVEF)] and so on.Independent sample t-test was used to compare the measurement data with normal distribution between the two groups,Mann-Whitney U test was used to compare the measurement data with non-normal distribution between the two groups,χ 2 test was used to compare the counting data between the two groups,and Logistic regression analysis was used for multivariate analysis.The working characteristic curve of the subjects was drawn and the area under the curve,the best critical value,sensitivity,specificity,positive likelihood ratio and negative likelihood ratio were calculated.To evaluate the predictive value of Child-Pugh grade and MELD score in the diagnosis of hepatitis B cirrhosis complicated with cirrhotic cardiomyopathy.Result: Univariate analysis showed that there were significant differences in age(t=2.333,P=0.021),Hb(t=-3.010,P=0.003),PT(Z=-2.434,P=0.015),Child-Pugh grade(χ~2=17.115,P=0.000),TBIL(Z=-2.475,P=0.013),ALB(t=-3.547,P=0.001),MELD score(t=-2.801,P=0.007),ascites(χ~2=9.221,P=0.002),HR(t=2.108,P=0.037),LAD(t=3.004,P=0.003).There was no statistical significance in gender(χ~2=0.031,P=0.861),WBC(Z=-1.374,P=0.169),PLT(Z=-0.848,P=0.396),PTA(t=-1.585,P=1.115),ALT(Z=-1.304,P=0.192),AST(Z=-1.143,P=0.253),CKMB(Z=-0.660,P=0.509),Cr(t=0.583,P=0.561),internal diameter of portal vein(t=0.112,P=0.911),LVDd(t=-0.014,P=0.989),LVDs(Z=0.105,P=0.917),LVEF(t=0.308,P=0.759).Multivariate Logistic regression analysis showed that the statistically significant variables affecting hepatitis B cirrhosis complicated with CCM were Child-Pugh grade(OR=3.794,95%CI:1.320~10.901)and MELD score(OR=1.218,95%CI:1.107~1.341),age(OR=1.079,95%CI:1.034~1.125)and Hb(OR=0.978,95%CI:0.962~0.994).The area under the curve of MELD score is 0.725,the cutoff value is 6.97 points,the sensitivity is 95.6%,the specificity is 42.00%,the Yoden index is 0.376,the positive likelihood ratio is 1.65,and the negative likelihood ratio is 0.001;The area under the curve of Child--Pugh classification is 0.710,the cutoff value is 7.50 points,the sensitivity is 82.2%,the specificity is 51.00%,the Yoden index is 0.332,the positive likelihood ratio is 1.68,and the negative likelihood ratio is 0.35;When MELD score and Child-Pugh score were combined to predict the diagnostic effect of CCM in patients with liver cirrhosis,the sensitivity,specificity,Yoden index,positive likelihood ratio and negative likelihood ratio were 86.70,56.00%,0.427,1.97 and 0.24 respectively.Conclusion: Child-Pugh grade,MELD score,Hb and age are independent influence factors of hepatitis B cirrhosis complicated with CCM.Child-Pugh grade and MELD are of high predictive value in the diagnosis of hepatitis B cirrhosis complicated with cirrhotic cardiomyopathy,and the combined prediction of hepatitis B cirrhosis complicated with CCM is better than that of a single index.