Novelli G, Rossi M, Ferretti G, Pugliese F, Travaglia D, Guidi S, Novelli S, Lai Q, Morabito V, Berloco P B
Dipartimento P Stefanini Chirurgia Generale e Trapianti d'Organo, La Sapienza Università di Roma, Rome, Italy.
Transplant Proc. 2010 May;42(4):1182-7. doi: 10.1016/j.transproceed.2010.03.095.
The aim of study was to highlight parameters that in association with Model for End-stage Liver Disease (MELD) provide predictive criteria for long-term survival after treatment with the Molecular Adsorbent Recirculating System (MARS). Two homogenous groups were studied: one treated with standard medical therapy (SMT) and the other, with MARS.
Twenty acute-on-chronic liver failure patients on the waiting list for liver transplantation and affected by alcoholic cirrhosis with similar MELD scores (20-29) were evaluated for 7 days from inclusion and for 6-month survival. Ten patients (seven males and three females) were treated with MARS. Their mean age was 48.5 years (range = 35-61). The number of MARS applications was six for 6 consecutive days, and the length of the applications was 8 hours. Ten other patients (seven males and three females) were treated with SMT, including prophylaxis against bacterial infections and judicious use of diuretics. The precipitating factors were also treated appropriately. The mean age of the patients was 51 years (range = 37-64). All the variables that were significant upon univariate analysis were enrolled in a receiver operating characteristic analysis, with the intention to detect predictive parameters for patient death at 6 months. We considered a significant area under curve (AUC) value to be greater than 0.5.
Among 11 patients who died within 6 months there were in the MARS group and eight in the SMT group: the 3- and 6-month patient survival rates were 90% and 70% versus 30% and 20% in the two groups, respectively. Nine measures resulted in an AUC > 0.5: DeltaMELD; interleukin (IL)-8; IL-6; tumor necrosis factor- alpha, MELD score; creatinine, bilirubin international normalized ratio (INR) and cardiac index. DeltaMELD and postoperative IL-8 concentrations showed better results (AUC = 0.899), followed by postoperative creatinine (AUC = 0.879), postoperative cardiac index (AUC = 0.833), and postoperative INR (AUC = 0.818). Postoperative creatinine showed the best sensitivity (100%), while IL-8, the best specificity (88.9%).
A combination of biochemical and clinical variables probably represent the best way to predict the survival of patients, allowing physicians to select the best therapies for each patient.
本研究旨在强调与终末期肝病模型（MELD）相关联的参数，这些参数可为分子吸附循环系统（MARS）治疗后的长期生存提供预测标准。研究了两个同质组：一组接受标准药物治疗（SMT），另一组接受MARS治疗。
对20例等待肝移植且患有酒精性肝硬化、MELD评分相似（20 - 29）的急性慢性肝衰竭患者进行了为期7天的纳入评估及6个月生存期的观察。10例患者（7例男性和3例女性）接受MARS治疗。他们的平均年龄为48.5岁（范围 = 35 - 61岁）。MARS应用次数为连续6天每天6次，每次应用时长为8小时。另外10例患者（7例男性和3例女性）接受SMT治疗，包括预防细菌感染和合理使用利尿剂。对诱发因素也进行了适当治疗。这些患者的平均年龄为51岁（范围 = 37 - 64岁）。所有在单因素分析中有显著意义的变量都纳入了受试者工作特征分析，旨在检测6个月时患者死亡的预测参数。我们认为曲线下面积（AUC）值大于0.5具有显著意义。
在6个月内死亡的11例患者中，MARS组有3例，SMT组有8例：两组患者3个月和6个月的生存率分别为90%和70%，以及30%和20%。9项指标的AUC > 0.5：MELD差值；白细胞介素（IL）-8；IL-6；肿瘤坏死因子-α、MELD评分；肌酐、胆红素国际标准化比值（INR）和心脏指数。MELD差值和术后IL-8浓度显示出更好的结果（AUC = 0.899），其次是术后肌酐（AUC = 0.879）、术后心脏指数（AUC = 0.833）和术后INR（AUC = 0.818）。术后肌酐显示出最佳敏感性（100%），而IL-8显示出最佳特异性（88.9%）。
生化和临床变量的组合可能是预测患者生存的最佳方法，可让医生为每位患者选择最佳治疗方案。
