Lisman Ton, van Leeuwen Yvonne, Adelmeijer Jelle, Pereboom Ilona T A, Haagsma Elizabeth B, van den Berg Arie P, Porte Robert J
Surgical Research Laboratory, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Liver Int. 2008 Dec;28(10):1344-51. doi: 10.1111/j.1478-3231.2008.01783.x. Epub 2008 May 14.
The model of end-stage liver disease (MELD) score is nowadays widely used to prioritize patients for liver transplantation.
To assess the contribution of the individual components of the MELD score in interlaboratory variability.
We sent 15 samples from patients listed for liver transplantation to seven different European laboratories who were asked to measure all three variables. In addition, 10 samples from patients on oral anticoagulant treatment were sent to the same labs for the international normalised ratio (INR) measurement.
In all 15 samples, a substantial and clinically relevant variation in the calculated MELD score was observed between laboratories. The mean difference in the MELD score between the highest- and the lowest-scoring laboratory was 4.8. The variation in creatinine measurements resulted in differences of up to three MELD points in a single patient when comparing the highest and the lowest scoring lab. The variation in bilirubin measurements only accounted for a difference of one point between the highest- and the lowest-scoring laboratory, but the variation in INRs resulted in differences of 2 to 12 MELD points. MELD scores or INR values were not substantially different in laboratories that used the Owren instead of the more widely used Quick methodology for INR measurements. The variability in the INR in patients on oral anticoagulants was substantially less as compared with the variability in patients with liver disease. In conclusion, we observed a large interlaboratory variation in the MELD score. This variation in the MELD score is primarily caused by the INR.
终末期肝病模型（MELD）评分如今被广泛用于确定肝移植患者的优先顺序。
评估MELD评分各组成部分在实验室间变异性中的作用。
我们将15份来自等待肝移植患者的样本送至7家不同的欧洲实验室，要求他们测量所有三个变量。此外，将10份来自接受口服抗凝治疗患者的样本送至同一实验室进行国际标准化比值（INR）测量。
在所有15份样本中，各实验室间计算出的MELD评分存在显著且具有临床相关性的差异。评分最高和最低的实验室之间MELD评分的平均差异为4.8。比较评分最高和最低的实验室时，肌酐测量值的差异导致单个患者的MELD评分相差多达3分。胆红素测量值的差异在评分最高和最低的实验室之间仅为1分，但INR的差异导致MELD评分相差2至12分。在使用奥伦（Owren）法而非更广泛使用的奎克（Quick）法进行INR测量的实验室中，MELD评分或INR值并无显著差异。与肝病患者相比，口服抗凝剂患者INR的变异性明显较小。总之，我们观察到各实验室间MELD评分存在较大差异。MELD评分的这种差异主要由INR引起。
