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Srpski arhiv za celokupno lekarstvo
2020, vol. 148, br. 3-4, str. 153-159
jezik rada: engleski
vrsta rada: originalan članak
objavljeno: 20/04/2020
doi: 10.2298/SARH190511093M
Procena ishoda lečenja bolesnika sa akutizacijom hronične insuficijencije jetre primenom kliničkih skorova
aUniverzitet u Beogradu, Medicinski fakultet + Klinički centar Srbije, Klinika za gastroenterohepatologiju, Beograd
bKlinički centar Srbije, Klinika za gastroenterohepatologiju, Beograd
cKlinički centar Srbije, Klinika za nefrologiju, Beograd
dMayo Clinic Health System, Department of Medicine, Eau Claire, Wisconsin, USA + Mayo Clinic School of Medicine and Sciences, Rochester, Minnesota, USA

e-adresa: dragasevicsanja@gmail.com

Sažetak

Uvod/Cilj Rana identifikacija i intenzivna terapija su neophodne kod bolesnika sa akutizacijom hronične insuficijencije jetre (AHIJ) zbog veoma visokog rizika od smrtnosti. Precizna predikcija je presudna za određivanje stepena hitnosti i adekvatnost terapije s obzirom na mortalitet i kliničke resurse. Cilj naše studije bio je da odredimo tačne granične vrednosti različitih prognostičkih skorova u predikciji mortaliteta od AHIJ. Metode Ova prospektivna studija obuhvatila je bolesnike sa hroničnom insuficijencijom jetre (HIJ) hospitalizovane zbog dekompenzacije i kasnije dijagnostikovane AHIJ u jedinici intenzivne nege. Svi bolesnici su procenjeni prema različitim prognostičkim skorovima, uključujući Čajld-Pju, MELD Na, MELD, SOFA, APACHE II i CLIF C, koji su izračunati na prijemu. Rezultati Alkoholna bolest jetre bila je najčešći uzrok HIJ (77,9%), zatim virusna (8,6%), autoimuna (7,7%) i druga (5,8%). Ukupno 37,5% bolesnika je umrlo na kraju prvog meseca lečenja. Prosečne vrednosti Child-Pugh, MELD Na, MELD, SOFA, APACHE II i CLIF C su bile značajno veće kod bolesnika koji su umrli u odnosu na preživele (p < 0,05). CLIF C skor je imao najbolji učinak sa graničnom vrednošću od 50,5, senzitivnošću 94,9% i specifičnošću od 40%. Zaključci AHIJ predstavlja stanje sa visokom kratkoročnom smrtnošću. Od svih skorova koji su analizirani u našoj studiji, CLIF C se pokazao kao najbolji skor za predikciju krajnjeg mortaliteta bolesnika sa AHIJ.

Ključne reči

insuficijencija jetre; AHIJ; prognoza; mortalitet; skorovi

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