Trotter J F, Olson J, Lefkowitz J, Smith A D, Arjal R, Kenison J
University of Colorado Health Sciences Center, Denver, CO, USA.
Am J Transplant. 2007 Jun;7(6):1624-8. doi: 10.1111/j.1600-6143.2007.01822.x.
Priority for liver transplantation is based on the Model for Endstage Liver Disease (MELD) score, a mathematical function which includes international normalized ratio (INR). We present an analysis to determine the lab-to-lab variation in INR at 14 clinical laboratories across the United States. We performed a survey to identify representative clinical laboratories across the United States, where INR was measured in the determination of MELD score. Five 'standard' samples for INR were formulated and were sent to the 14 clinical laboratories to determine variation in INR and MELD score. Among the 14 clinical laboratories, the range in INR for the five samples was: sample 1 (1.2-2.0), sample 2 (1.4-2.5), sample 3 (1.7-3.4), sample 4 (1.9-3.7) and sample 5 (2.4-5.1). The range in calculated MELD score was: sample 1 (8-14), sample 2 (10-17), sample 3 (12-20), sample 4 (14-21) and sample 5 (16-25). The selection of the clinical laboratory used to determine INR may result in substantial changes in MELD score independent of severity-of-illness. These data suggest that further review of interlaboratory variation in MELD should be undertaken because of the potential impact on prioritization for liver transplantation.
肝移植的优先级基于终末期肝病模型（MELD）评分，这是一个包含国际标准化比值（INR）的数学函数。我们进行了一项分析，以确定美国14家临床实验室之间INR的实验室间差异。我们开展了一项调查，以识别美国各地具有代表性的临床实验室，这些实验室在测定MELD评分时会检测INR。我们配制了5个INR的“标准”样本，并将其发送至14家临床实验室，以确定INR和MELD评分的差异。在这14家临床实验室中，5个样本的INR范围为：样本1（1.2 - 2.0），样本2（1.4 - 2.5），样本3（1.7 - 3.4），样本4（1.9 - 3.7）和样本5（2.4 - 5.1）。计算出的MELD评分范围为：样本1（8 - 14），样本2（10 - 17），样本3（12 - 20），样本4（14 - 21）和样本5（16 - 25）。用于确定INR的临床实验室的选择可能会导致MELD评分出现大幅变化，而与疾病严重程度无关。这些数据表明，鉴于对肝移植优先级的潜在影响，应进一步审查MELD的实验室间差异。
