Prognostic Factors in Cirrhosis Identified by Cox's Regression Model

In a controlled clinical trial in 488 patients with chronic liver disease treated with prednisone or placebo, survival data were analyzed using Cox's proportional hazards model. A total of 162 variables were screened separately for prognostic and/or therapeutic effect by log‐rank analyses, whereby 46 clinical, biochemical, serological, and histological variables were isolated. Another five variables traditionally found to be important in patients with liver disease were included. After extensively checking the assumptions of the model, the 51 variables were, by a step‐wise procedure, reduced to a final model. It comprised, besides a treatment indicator, 12 variables with significant (p < 0.05) prognostic or therapeutic effect. The following eight variables had a significant prognostic effect: sex, age, prothrombin, acetylcholinesterase, eosinophil leucocytes in liver parenchyma, liver cell necrosis, inflammation in liver connective tissue, and efferent veins in parenchymal nodules. A prognostic index based on the final model is formed allowing calculation of 5 years survival probability. The usefulness of the prognostic index was tested by a cross‐validation method, and no statistical significant difference was found between the estimated and observed survivorship functions.

[1]  N. Breslow,et al.  Analysis of Survival Data under the Proportional Hazards Model , 1975 .

[2]  Measuring Prognosis Using the Proportional Hazards Model , 1983 .

[3]  J. Crowley,et al.  Covariance Analysis of Heart Transplant Survival Data , 1977 .

[4]  J. Peto,et al.  Asymptotically Efficient Rank Invariant Test Procedures , 1972 .

[5]  R. Kay,et al.  Proportional Hazard Regression Models and the Analysis of Censored Survival Data , 1977 .

[6]  Per Kragh Andersen,et al.  Testing Goodness of Fit of Cox's Regression and Life Model , 1982 .

[7]  S. Rasmussen,et al.  Long-term prognosis after acute myocardial infarction. A multivariate stepwise analysis. , 1979, Danish medical bulletin.

[8]  David R. Cox,et al.  Regression models and life tables (with discussion , 1972 .

[9]  E. Christensen,et al.  Clinical relevance of restrictive morphological criteria for the diagnosis of cirrhosis in liver biopsies. , 2008, Liver.

[10]  H. Popper,et al.  Pathogenesis of postnecrotic cirrhosis in alcoholics. , 1962, Archives of pathology.

[11]  E. Kjøller Long-term prognosis after acute myocardial infarction. , 1975, Danish medical bulletin.

[12]  V. Farewell An Application of Cox's Proportional Hazard Model to Multiple Infection Data , 1979 .

[13]  C. Balch,et al.  A multifactorial analysis of melanoma. II. Prognostic factors in patients with stage I (localized) melanoma. , 1979, Surgery.

[14]  E. Beale,et al.  Missing Values in Multivariate Analysis , 1975 .