将血清钠浓度基于证据纳入终末期肝病模型（MELD）

Evidence-based incorporation of serum sodium concentration into MELD.

作者信息

Biggins Scott W, Kim W Ray, Terrault Norah A, Saab Sammy, Balan Vijay, Schiano Thomas, Benson Joanne, Therneau Terry, Kremers Walter, Wiesner Russell, Kamath Patrick, Klintmalm Goran

机构信息

University of California San Francisco, San Francisco, California, USA.

出版信息

Gastroenterology. 2006 May;130(6):1652-60. doi: 10.1053/j.gastro.2006.02.010.

DOI:10.1053/j.gastro.2006.02.010

PMID:16697729

Abstract

BACKGROUND & AIMS: Serum sodium (Na) concentrations have been suggested as a useful predictor of mortality in patients with end-stage liver disease awaiting liver transplantation.

METHODS

We evaluated methods to incorporate Na into model for end-stage liver disease (MELD), using a prospective, multicenter database specifically created for validation and refinement of MELD. Adult, primary liver transplant candidates with end-stage liver disease were enrolled.

RESULTS

Complete data were available in 753 patients, in whom the median MELD score was 10.8 and sodium was 137 mEq/L. Low Na (<130 mEq/L) was present in 8% of patients, of whom 90% had ascites. During the study period, 67 patients (9%) died, 243 (32%) underwent transplantation, 73 (10%) were withdrawn, and 370 were still waiting. MELD score and Na, at listing, were significant (both, P < .01) predictors of death within 6 months. After adjustment for MELD score and center, there was a linear increase in the risk of death as Na decreased between 135 and 120 mEq/L. A new score to incorporate Na into MELD was developed: "MELD-Na" = MELD + 1.59 (135 - Na) with maximum and minimum Na of 135 and 120 mEq/L, respectively. In this cohort, "MELD-Na" scores of 20, 30, and 40 were associated with 6%, 16%, and 37% of risk of death within 6 months of listing, respectively. If this new score were used to allocate grafts, it would affect 27% of the transplant recipients.

CONCLUSIONS

We demonstrate an evidence-based method to incorporate Na into MELD, which provides more accurate survival prediction than MELD alone.

摘要

背景与目的

血清钠（Na）浓度被认为是等待肝移植的终末期肝病患者死亡率的有用预测指标。

方法

我们使用专门为终末期肝病模型（MELD）的验证和完善而创建的前瞻性多中心数据库，评估了将钠纳入MELD模型的方法。纳入了患有终末期肝病的成年原发性肝移植候选者。

结果

753例患者有完整数据，其中位MELD评分为10.8，钠浓度为137 mEq/L。8%的患者存在低钠血症（<130 mEq/L），其中90%有腹水。在研究期间，67例患者（9%）死亡，243例（32%）接受了移植，73例（10%）退出研究，370例仍在等待。登记时的MELD评分和钠浓度是6个月内死亡的显著预测指标（均P <.01）。在调整MELD评分和中心因素后，随着钠浓度在135至120 mEq/L之间降低，死亡风险呈线性增加。开发了一种将钠纳入MELD的新评分：“MELD-Na” = MELD + 1.59（135 - Na），钠的最大值和最小值分别为135和120 mEq/L。在该队列中，登记后6个月内，“MELD-Na”评分为20、30和40分别与6%、16%和37%的死亡风险相关。如果使用这个新评分来分配移植物，将影响27%的移植受者。