Lv Xiao-Hui, Liu Hong-Bo, Wang Ying, Wang Bing-Yuan, Song Min, Sun Ming-Jun
Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning Province, China.
J Gastroenterol Hepatol. 2009 Sep;24(9):1547-53. doi: 10.1111/j.1440-1746.2009.05913.x. Epub 2009 Aug 3.
To evaluate the prognostic ability of model for end-stage liver disease (MELD) to serum sodium (SNa) ratio (MESO) index and to compare the predictive accuracy of the MESO index with the MELD score and the modified Child-Turcotte-Pugh (CTP) score for short-term survival in cirrhotic patients.
A total of 256 patients with cirrhosis were retrospectively evaluated. The predictive accuracy of the MESO index, MELD score and modified CTP score were compared by the area under the receiver-operator characteristic curve (AUC).
Using 1-month and 3-month mortality as the end-point, overall, MESO and MELD were significantly better than the CTP score in predicting the risk of mortality at 1 month (AUC, 0.866,0.819 vs 0.722, P < 0.01) and 3 months (AUC, 0.875,0.820 vs 0.721, P < 0.01). In the low MELD group, the AUC of MESO index (0.758, 0.759) and CTP score (0.754, 0.732) were higher than that of the MELD score (0.608, 0.611) at 1 month and 3 months, respectively (P < 0.01). However, in the high MELD group, the AUC of MESO index (0.762, 0.779) and MELD (0.737, 0.773) were higher than that of the CTP score (0.710, 0.752) at 1 month and 3 months, respectively, although there were no significant differences (P > 0.05). With appropriate cut-offs for the MESO index, the mortality rate of patients in high MESO was higher (57.1% at 1 month and 69.2% at 3 months) than that of the low MESO (5.5% at 1 month and 7.9% at 3 months) (P < 0.01).
The MESO index, which adds SNa to MELD, is a useful prognostic marker and is found to be superior to the MELD score and modified CTP score for short-term prognostication of patients with cirrhosis.
评估终末期肝病模型（MELD）与血清钠（SNa）比值（MESO）指数的预后能力，并比较MESO指数与MELD评分及改良Child-Turcotte-Pugh（CTP）评分对肝硬化患者短期生存的预测准确性。
对256例肝硬化患者进行回顾性评估。通过受试者工作特征曲线下面积（AUC）比较MESO指数、MELD评分和改良CTP评分的预测准确性。
以1个月和3个月死亡率为终点，总体而言，MESO和MELD在预测1个月（AUC分别为0.866、0.819 vs 0.722，P<0.01）和3个月（AUC分别为0.875、0.820 vs 0.721，P<0.01）死亡率风险方面显著优于CTP评分。在低MELD组中，MESO指数（0.758，0.759）和CTP评分（0.754，0.732）在1个月和3个月时的AUC分别高于MELD评分（0.608，0.611）（P<0.01）。然而，在高MELD组中，MESO指数（0.762，0.779）和MELD（0.737，0.773）在1个月和3个月时的AUC分别高于CTP评分（0.710，0.752），尽管差异无统计学意义（P>0.05）。采用MESO指数的合适截断值，高MESO患者的死亡率（1个月时为57.1%，3个月时为69.2%）高于低MESO患者（1个月时为5.5%，3个月时为7.9%）（P<0.01）。
将SNa加入MELD的MESO指数是一种有用的预后标志物，在肝硬化患者短期预后评估中优于MELD评分和改良CTP评分。
