Huo Teh-Ia, Wang Ying-Wen, Yang Ying-Ying, Lin Han-Chieh, Lee Pui-Ching, Hou Ming-Chih, Lee Fa-Yauh, Lee Shou-Dong
Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Liver Int. 2007 May;27(4):498-506. doi: 10.1111/j.1478-3231.2007.01445.x.
The models for end-stage liver disease (MELD) and serum sodium (SNa) are important prognostic markers in cirrhosis. A novel index, MELD to SNa ratio (MESO), was developed to amplify the opposing effect of MELD and SNa on outcome prediction.
A total of 213 cirrhotic patients undergoing hepatic venous pressure gradient (HVPG) measurement were retrospectively analyzed.
The MESO index correlated with HVPG (r=0.258, P<0.001) and Child-Pugh score (rho=0.749, P<0.001). Using mortality as the end point, the area under receiver operating characteristic curve (AUC) was 0.860 for SNa, 0.795 for the MESO index and 0.789 for MELD (P values all >0.3) at 3 months. Among patients with Child-Pugh class A or B, the MESO index had a significantly higher AUC compared with MELD (0.80 vs. 0.766, P<0.001). A MESO index <1.6 identified 97% of patients who survived at 3 months and the predicted survival rate was 96.5%. In survival analysis, MESO index >1.6 independently predicted a higher mortality rate (relative risk: 3.32, P<0001) using the Cox model.
The MESO index, which takes into account the predictive power of both MELD and SNa, is a useful prognostic predictor for both short- and long-term survival in cirrhotic patients.
终末期肝病模型（MELD）和血清钠（SNa）是肝硬化重要的预后指标。一种新的指标，即MELD与SNa比值（MESO）被开发出来，以增强MELD和SNa在结局预测方面的相反作用。
对总共213例接受肝静脉压力梯度（HVPG）测量的肝硬化患者进行回顾性分析。
MESO指数与HVPG相关（r = 0.258，P < 0.001）以及与Child-Pugh评分相关（rho = 0.749，P < 0.001）。以死亡率作为终点，3个月时血清钠的受试者工作特征曲线下面积（AUC）为0.860，MESO指数为0.795，MELD为0.789（P值均> 0.3）。在Child-Pugh A或B级患者中，MESO指数的AUC显著高于MELD（0.80对0.766，P < 0.001）。MESO指数<1.6可识别出97%在3个月时存活的患者，预测生存率为96.5%。在生存分析中，使用Cox模型，MESO指数>1.6独立预测更高的死亡率（相对风险：3.32，P < 0.001）。
考虑到MELD和SNa两者预测能力的MESO指数，是肝硬化患者短期和长期生存的有用预后预测指标。
