Cai Chang-jie, Lu Min-qiang, Cong Yu-tian, Chen Hu-an, Chen Gui-hua
Liver Transplantation Center of the Third Affiliated Hospital of Sun Yat-sen University, Transplantation Institute of Sun Yat-sen University, Guangzhou 510630, China.
Zhonghua Gan Zang Bing Za Zhi. 2007 Jun;15(6):408-11.
To investigate the prognosis evaluation and treatment strategy of chronic severe hepatitis (CSH) patients using a model of end-stage liver disease (MELD).
The MELD scores of 135 CSH patients on the day of their admittance to our hospital and the DeltaMELD scores after two-weeks of medical treatment were retrospectively analyzed. They were also compared with the scores of the three-month mortality rate of the patients.
The mean MELD score calculated on the first day of the patients who died after their admission to the hospital was 37.00+/-6.50, while that of the living group was 25.80+/-5.20. The difference was highly significant (chi(2)=72.00, P < 0.01). MELD score after two-weeks medical treatment of the patients who died was 1.57+/-0.89, while that of the living group was -0.99+/-0.73; the difference was also highly significant (chi(2)=56.35, P < 0.01). The area under the ROC curve of MELD score (c-statistic) was 0.90, while the c-statistic for DeltaMELD score was 0.76. On the first day of their admission, when the MELD score was < 25, the three-month mortality rate was 2%; when it was 25 <or= MELD <or= 30, the three-month mortality rate was 7%; when it was 30 <MELD score < 35, the three-month mortality rate was 43%; and when MELD score >or= 35, the three-month mortality rate was 81%; the differences between these groups were all highly significant (P less than 0.01). When MELD scores were above zero, the three-month mortality was 51%, and when DeltaMELD scores were less than or equal to zero, the three-month mortality rate was 13%. All the differences were highly significant (P < 0.01).
A high MELD score and a high Delta MELD score herald high three-month mortality rates in patients with CSH. MELD is quite usable in assessing the prognosis in patients suffering CSH. The choice of treatment for the CSH patients could be made by integrating the MELD score calculated on the first day of being admitted to a hospital and the Delta MELD score after their medical treatment.
采用终末期肝病模型（MELD）探讨慢性重型肝炎（CSH）患者的预后评估及治疗策略。
回顾性分析135例CSH患者入院当日的MELD评分及治疗2周后的DeltaMELD评分，并与患者3个月死亡率的评分进行比较。
入院后死亡患者首日计算的平均MELD评分为37.00±6.50，存活组为25.80±5.20，差异有高度统计学意义（χ²=72.00，P<0.01）。死亡患者治疗2周后的MELD评分为1.57±0.89，存活组为-0.99±0.73，差异也有高度统计学意义（χ²=56.35，P<0.01）。MELD评分的ROC曲线下面积（c统计量）为0.90，DeltaMELD评分的c统计量为0.76。入院首日，MELD评分<25时，3个月死亡率为2%；25≤MELD≤30时，3个月死亡率为7%；30<MELD评分<35时，3个月死亡率为43%；MELD评分≥35时，3个月死亡率为81%，各组间差异均有高度统计学意义（P<0.01）。MELD评分大于零时，3个月死亡率为51%，DeltaMELD评分小于或等于零时，3个月死亡率为13%，所有差异均有高度统计学意义（P<0.01）。
高MELD评分和高DeltaMELD评分预示CSH患者3个月死亡率高。MELD在评估CSH患者预后方面相当有用。CSH患者的治疗选择可通过综合入院首日计算的MELD评分及治疗后的DeltaMELD评分来确定。
