Briceño J, Sánchez-Hidalgo J M, Naranjo A, Ciria R, Pozo J C, Luque A, de la Mata M, Rufián S, López-Cillero P
Liver Transplantation Unit, Hospital Reina Sofía, Cordoba, Spain.
Transplant Proc. 2008 Nov;40(9):2952-4. doi: 10.1016/j.transproceed.2008.09.023.
Postoperative Model for End-stage Liver Disease (MELD) values have never been assessed to predict very early (<1 week) death after liver transplantation (OLT). We retrospectively reviewed 275 consecutive OLTs performed in 252 recipients reported in a prospective database. We calculated the MELD score (pre-MELD) and consecutive postoperative MELD (post-MELD) scores computed daily during the first postoperative week and on days 15 and 30 after OLT. Post-MELD scores from nonsurviving recipients displayed on a scatterplot of immediate probability of death were adjusted to the best goodness-of-fit curve, and, finally, depicted graphically as a receiver operating characteristic (ROC) curve. Nonsurviving recipients showed higher post-MELD scores: day 1: 23.5 versus 16.6 (P = .05); day 3: 25.1 versus 12.5 (P = .000); day 5: 25.7 versus 11.8 (P = .000); and day 7: 22.1 versus 10.2 (P = .000). Overall comparisons were performed using a time-dependent general linear regression model, revealing higher post-MELD scores for nonsurviving recipients, irrespective of postoperative time (P = .002). The best goodness-of-fit curve was displayed when adjusting to a theoretical exponential regression curve calculated as follows: Probability of dying within the first week (%) = 3.36 x e(0.079 x (post-MELD)) (r = .89; P = .000). The area under the ROC curve was 0.783 (95% confidence interval, 0.630-0.935; P = .001). The model had a positive predictive value of 82.3%, a negative predictive value of 33.1%, and an accuracy of 79.2%. In conclusion, this study corroborated the suggestion that the MELD score may serve as a reliable tool to assess very early death after OLT.
终末期肝病模型（MELD）评分从未被用于评估肝移植（OLT）后极早期（<1周）死亡的预测情况。我们回顾性分析了前瞻性数据库中252例接受者的275例连续OLT手术。我们计算了MELD评分（术前MELD）以及术后第一周每日计算的连续术后MELD（术后MELD）评分，还有OLT后第15天和第30天的评分。将未存活接受者的术后MELD评分绘制在死亡即时概率散点图上，并根据最佳拟合曲线进行调整，最后以受试者工作特征（ROC）曲线的形式进行图形化展示。未存活接受者的术后MELD评分更高：第1天：23.5对16.6（P = 0.05）；第3天：25.1对12.5（P = 0.000）；第5天：25.7对11.8（P = 0.000）；第7天：22.1对10.2（P = 0.000）。总体比较采用时间依赖性一般线性回归模型进行，结果显示未存活接受者的术后MELD评分更高，与术后时间无关（P = 0.002）。调整为如下计算的理论指数回归曲线时，显示出最佳拟合曲线：第一周内死亡概率（%）= 3.36×e(0.079×(术后MELD))（r = 0.89；P = 0.000）。ROC曲线下面积为0.783（95%置信区间，0.630 - 0.935；P = 0.001）。该模型的阳性预测值为82.3%，阴性预测值为33.1%，准确性为79.2%。总之，本研究证实了MELD评分可作为评估OLT后极早期死亡的可靠工具这一观点。
