Sarvary E, Seregely Zs, Fazakas J, Kovacs F, Gaal I, Beko G, Varga J, Kobori L, Nemes B, Gorog D, Varga M, Langer R M, Monostory K, Jaray J, Gerlei Zs
Semmelweis Medical University, Transplantation and Surgical Clinic Budapest, Budapest, Hungary.
Transplant Proc. 2010 Jul-Aug;42(6):2317-22. doi: 10.1016/j.transproceed.2010.05.011.
Priority for liver transplantation is currently based on the Model for End-stage Liver Disease (MELD) score. The aim of our study was to assess in detail the contribution of international normalized ratio (INR) differences for MELD scores because of interlaboratory variability. The samples from 92 cirrhotic patients were measured on different systems combining three coagulometers and three thromboplastin products to determine variations in INR and MELD score. The INR differences among the first four systems varied between 0 and 0.2, resulting in MELD differences of 0 to 2. The MELD scores of 92 patients changed only among 10 possible integers so that normally 2 to 10 patients shared the same MELD value. In some cases, one MELD score difference resulted in a 10 superpositioning on the waiting list. Including one more system (mechanical vs optical) into our investigations achieved a five MELD difference. Supposing an extreme situation where one patient competes with his or her lowest, all the other with their highest possible score (and visa versa), the difference may be even 20 positions, overturning the complete waiting list. In conclusion substantial interlaboratory differences in MELD score have profound clinical consequences.
目前，肝移植的优先级是基于终末期肝病模型（MELD）评分。我们研究的目的是详细评估由于实验室间差异导致的国际标准化比值（INR）差异对MELD评分的影响。从92例肝硬化患者采集样本，在结合三种凝血仪和三种凝血活酶产品的不同系统上进行检测，以确定INR和MELD评分的变化。前四个系统之间的INR差异在0到0.2之间，导致MELD差异为0到2。92例患者的MELD评分仅在10个可能的整数之间变化，因此通常有2至10名患者共享相同的MELD值。在某些情况下，MELD评分的一个差异会导致在等待名单上有10个重叠。在我们的研究中增加一个系统（机械法与光学法）后，MELD差异达到了5。假设一种极端情况，一名患者以其最低分参与竞争，而其他所有患者以其最高分参与竞争（反之亦然），差异甚至可能达到20个名次，从而颠覆整个等待名单。总之，MELD评分在实验室间存在的显著差异具有深远的临床后果。
