Iacob S, Gheorghe L, Iacob R, Gheorghe C, Hrehoreţ D, Popescu I
Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania.
Chirurgia (Bucur). 2009 May-Jun;104(3):267-73.
Cirrhosis related complications, considered MELD exceptions, proved to add prognostic value to the MELD score in predicting waiting list mortality.
To identify the predictive value for death on a long waiting list (WL) for the complications of liver disease.
During 2004-2007, 372 consecutive adult patients were listed for liver transplantation (LT). To identify the potential predictors of patient death, univariate and multivariate Cox's proportional hazards regression model was used.
In the univariate survival analysis the following variables were significant: spontaneous bacterial peritonitis, refractory ascites, hyponatremia, hepatic encephalopathy, hepatorenal syndrome, initial and current MELD score, initial and current Child-Pugh score. The independent predictors of death on our WL were: refractory ascites (p=0.002) and hepatorenal syndrome (p=0.002). Based on a logistic regression analysis a new score has been developed: Score = 1/(1+ exp(-(-4.38 + 1.34 x Refractory ascites + 0.9 x Hepatorenal syndrome + 0.15 x Current MELD). The c-statistic for the new score for prediction of death on the WL was 0.85 compared to 0.80 for current MELD score.
Refractory ascites and hepatorenal syndrome should add valuable points to the current MELD in order to better prioritize for LT patients included on long WL.
Liver transplantation (LT), Model for End-Stage Liver Disease (MELD), waiting list (WL), United Network for Organ Sharing (UNOS), standard deviation (SD), receiver operating characteristic (ROC), hepatitis B virus (HBV), hepatocellular carcinoma (HCC), positive predictive value (PPV), negative predictive value (NPV), Child-Turcotte-Pugh (CTP), hepatic venous pressure gradient (HVPG).
肝硬化相关并发症被视为终末期肝病模型（MELD）的例外情况，已证明其在预测等待名单上的死亡率时可为MELD评分增加预后价值。
确定肝病并发症对长期等待名单（WL）上患者死亡的预测价值。
在2004年至2007年期间，372例连续的成年患者被列入肝移植（LT）等待名单。为了确定患者死亡的潜在预测因素，使用了单变量和多变量Cox比例风险回归模型。
在单变量生存分析中，以下变量具有显著性：自发性细菌性腹膜炎、难治性腹水、低钠血症、肝性脑病、肝肾综合征、初始和当前MELD评分、初始和当前Child-Pugh评分。我们等待名单上患者死亡的独立预测因素为：难治性腹水（p = 0.002）和肝肾综合征（p = 0.002）。基于逻辑回归分析开发了一个新的评分：评分 = 1 /（1 + exp（-（-4.38 + 1.34×难治性腹水 + 0.9×肝肾综合征 + 0.15×当前MELD））。用于预测等待名单上患者死亡的新评分的c统计量为0.85，而当前MELD评分为0.80。
难治性腹水和肝肾综合征应在当前MELD基础上增加有价值的分数，以便更好地对长期等待名单上的肝移植患者进行优先排序。
肝移植（LT）、终末期肝病模型（MELD）、等待名单（WL）、器官共享联合网络（UNOS）、标准差（SD）、受试者工作特征曲线（ROC）、乙型肝炎病毒（HBV）、肝细胞癌（HCC）、阳性预测值（PPV）、阴性预测值（NPV）、Child-Turcotte-Pugh（CTP）、肝静脉压力梯度（HVPG）
