Wong Vincent Wai-Sun, Chim Angel Mei-Ling, Wong Grace Lai-Hung, Sung Joseph Jao-Yao, Chan Henry Lik-Yuen
Institute of Digestive Disease and Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Republic of China.
Liver Transpl. 2007 Sep;13(9):1228-35. doi: 10.1002/lt.21222.
The new Model for End-Stage Liver Disease (MELD)-Na score has been validated in a population predominantly affected by chronic hepatitis C and alcoholic liver disease. We aimed to validate the score in Chinese patients with chronic hepatitis B-related complications admitted to the hospital from 1996 to 2003. MELD and the new MELD-Na scores (MELD-Na = MELD + 1.59 [135 - Na] with maximum and minimum Na of 135 and 120 mmol/L, respectively) on initial admissions were calculated. Cox proportional hazard model was used to assess factors associated with mortality. The area under the receiver operator characteristic curve (AUC) was used to compare the predictive abilities of MELD and MELD-Na scores for 3-month and 1-yr mortalities. Patients with hepatocellular carcinoma were excluded. A total of 2,073 patients with liver disease were admitted during the study period and 363 patients had chronic hepatitis B-related complications other than hepatocellular carcinoma. At a median follow-up of 106 weeks, 134 patients died and 14 received liver transplantation. Patients with MELD-Na scores 11-20, 21-30, and >30 had mortality increased by 2.0-fold, 4.7-fold, and 7.6-fold, respectively, compared to patients with scores < or =10. At 3 months and 1 yr, the AUC of the MELD-Na score (0.75 and 0.79, respectively) was superior to those of the MELD score (0.72 and 0.75, respectively) (P = 0.004) in predicting mortality. In conclusion, the new MELD-Na score is a valid model to predict mortality in patients with complications of chronic hepatitis B.
终末期肝病新模型（MELD）-血钠评分已在以慢性丙型肝炎和酒精性肝病为主的人群中得到验证。我们旨在验证该评分在1996年至2003年期间入院的慢性乙型肝炎相关并发症中国患者中的有效性。计算了初次入院时的MELD和新的MELD-血钠评分（MELD-血钠 = MELD + 1.59×[135 - 血钠]，血钠最高值和最低值分别为135和120 mmol/L）。采用Cox比例风险模型评估与死亡率相关的因素。使用受试者工作特征曲线下面积（AUC）比较MELD和MELD-血钠评分对3个月和1年死亡率的预测能力。排除肝细胞癌患者。研究期间共收治2073例肝病患者，其中363例患有除肝细胞癌以外的慢性乙型肝炎相关并发症。中位随访106周时，134例患者死亡，14例接受了肝移植。与评分≤10的患者相比，MELD-血钠评分11 - 20、21 - 30和>30的患者死亡率分别增加了2.0倍、4.7倍和7.6倍。在预测3个月和1年死亡率方面，MELD-血钠评分的AUC（分别为0.75和0.79）优于MELD评分的AUC（分别为0.72和0.75）（P = 0.004）。总之，新的MELD-血钠评分是预测慢性乙型肝炎并发症患者死亡率的有效模型。
