Chen Hu-an, Chen Ying-hua, Zhao Hui, Yi Shu-hong, Zhang Jun-feng, Meng Wei, Cai Chang-jie, Lu Min-qiang, Chen Gui-hua
Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Transplantation Institute of Sun Yat-sen University, Guangzhou 510630, China.
Zhonghua Wai Ke Za Zhi. 2009 Dec 1;47(23):1771-4.
To study the practical use of the serum sodium incorporated model for end-stage liver disease (MELD-Na) on clinic and to assess its validity by the concordance-statistic in predicting the prognosis of the patients with chronic severe hepatitis B.
Adult patients with a diagnosis of chronic severe hepatitis B between January 2007 and December 2007 in a single center were analyzed. The serum sodium, MELD, MELD-Na, and Delta MELD-Na (Delta MELD=MELD score at 14 days after medical treatment-MELD score at admission) scores of 426 patients with chronic severe hepatitis B were calculated. The 3-month mortality in patients was measured, and the validity of the models was determined by means of the concordance-statistic.
The area under the receiver-operating characteristic curves of Na, MELD and MELD-Na for the occurrence of death in 3 month were 0.718, 0.875 and 0.922. The 3-month mortality of the MELD-Na scores group <25, 25-30, >30-35, >35- <40 and > or = 40 were 2.0%, 5.4%, 35.4%, 53.8% and 86.9% respectively. There was a significant difference of 3-month mortality between the five groups (P<0.05). The 3-month mortality of Delta MELD-Na> 0 group was 65.9%, and the Delta MELD-Na < or = 0 group was 15.8%. There was a significant difference of 3-month mortality between the two groups (P<0.05).
MELD-Na score is a valid model to predict 3-month mortality in patients with chronic severe hepatitis B. Delta MELD-Na is clinically useful parameters for predicting the therapeutic effect of chronic severe hepatitis B.
研究终末期肝病血清钠整合模型（MELD-Na）在临床上的实际应用，并通过一致性统计量评估其预测慢性重型乙型肝炎患者预后的有效性。
分析2007年1月至2007年12月在单一中心诊断为慢性重型乙型肝炎的成年患者。计算426例慢性重型乙型肝炎患者的血清钠、MELD、MELD-Na和Delta MELD-Na（Delta MELD = 治疗后14天的MELD评分 - 入院时的MELD评分）评分。测量患者的3个月死亡率，并通过一致性统计量确定模型的有效性。
Na、MELD和MELD-Na预测3个月内死亡的受试者工作特征曲线下面积分别为0.718、0.875和0.922。MELD-Na评分组<25、25 - 30、>30 - 35、>35 - <40和>或 = 40的3个月死亡率分别为2.0%、5.4%、35.4%、53.8%和86.9%。五组之间的3个月死亡率有显著差异（P<0.05）。Delta MELD-Na>0组的3个月死亡率为65.9%，Delta MELD-Na<或 = 0组为15.8%。两组之间的3个月死亡率有显著差异（P<0.05）。
MELD-Na评分是预测慢性重型乙型肝炎患者3个月死亡率的有效模型。Delta MELD-Na是预测慢性重型乙型肝炎治疗效果的临床有用参数。
