Wong Zhi-Hong, Cai Shu-Qing
Department of Infectious Diseases, Xiehe Hospital, Tongji Medical College, Huazhong Science and Technology University, Wuhan 430022, China.
Zhonghua Gan Zang Bing Za Zhi. 2005 Apr;13(4):249-51.
To study the practical use of the model for end-stage liver disease (MELD) in clinics and to assess its validity in predicting the prognoses of patients with severe viral hepatitis and to determine the validity of the model by the concordance (c)-statistic which is equivalent to the area under the receiver operating characteristic (ROC) curve. Also, the optimal cutoff values of MELD to discriminate between deceased and surviving patients were calculated using ROC curves.
121 patients were divided into a plasma exchange (PE) group and a non-plasma exchange (non-PE) group, and they were graded with the MELD formula. The death rate was observed within three months.
81 patients died within 3 months (35 cases in the PE group, 46 cases in the non-PE group). The mortality rates of patients in the PE group whose MELD scores were between 20 to 30 and 30 to 40 were 31.6% and 57.7% respectively, but in non-PE cases they were 67.6%, 81.3% respectively; there was a significant difference between the PE group and non-PE group. The mortality rates of patients whose MELD score was higher than 40 were 93.3% in the PE group and 100% in the non-PE group, however there was no significant difference between the two groups. The optimal cut-off values of MELD to predict the prognoses of patients were 30 in the PE group whose sensitivity, specificity and c-statistic were 80.0%, 52.0% and 0.777, but in the non-PE group they were 25, 82.6%, 86.7% and 0.869, respectively.
This study suggests that MELD scores can serve as an index of the severity of the disease of patients with severe viral hepatitis, and that the mortality rates of the patients increase with the increase of their MELD scores. MELD can accurately predict the short-term prognoses of patients with severe viral hepatitis.
研究终末期肝病模型（MELD）在临床中的实际应用，评估其对重型病毒性肝炎患者预后的预测效度，并通过等同于受试者工作特征（ROC）曲线下面积的一致性（c）统计量来确定该模型的效度。此外，利用ROC曲线计算MELD区分死亡和存活患者的最佳截断值。
将121例患者分为血浆置换（PE）组和非血浆置换（非PE）组，并用MELD公式进行分级。观察三个月内的死亡率。
81例患者在3个月内死亡（PE组35例，非PE组46例）。PE组中MELD评分在20至30之间和30至40之间的患者死亡率分别为31.6%和57.7%，而非PE组分别为67.6%、81.3%；PE组和非PE组之间存在显著差异。MELD评分高于40的患者死亡率在PE组为93.3%，在非PE组为100%，但两组之间无显著差异。PE组中预测患者预后的MELD最佳截断值为30，其敏感性、特异性和c统计量分别为80.0%、52.0%和0.777，而非PE组分别为25、82.6%、86.7%和0.869。
本研究表明，MELD评分可作为重型病毒性肝炎患者疾病严重程度的指标，且患者死亡率随MELD评分升高而增加。MELD能准确预测重型病毒性肝炎患者的短期预后。
