Inaba Kenji, Barmparas Galinos, Resnick Shelby, Browder Timothy, Chan Linda S, Lam Lydia, Talving Peep, Demetriades Demetrios
Division of Trauma Surgery and Surgical Critical Care, University of Southern California, Los Angeles County Medical Center, Los Angeles, CA 90033, USA.
Arch Surg. 2011 Sep;146(9):1074-8. doi: 10.1001/archsurg.2011.109. Epub 2011 May 16.
To examine the ability of the model for end-stage liver disease (MELD) score to predict the risk of mortality in trauma patients with cirrhosis. Although cirrhosis is associated with poor outcomes after injury, the relative effect of the severity of the cirrhosis on outcomes is unclear. The MELD score is a prospectively developed and validated scoring system, which is associated with increasing severity of hepatic dysfunction and risk of death in patients with chronic liver disease.
Retrospective review. The MELD score for each patient was calculated from the international normalized ratio, the serum creatinine level, and the serum total bilirubin level obtained from the patient at admission to the level 1 trauma center. The association of MELD score with mortality was assessed using logistic regression analysis.
Level 1 trauma center.
Cirrhotic patients with trauma admitted to the level 1 trauma center during the period from January 2003 to December 2009.
Mortality.
During the 7-year study period, 285 injured cirrhotic patients were admitted. The mean (SD) age was 50.0 (10.5) years, and the mean (SD) MELD score was 11.7 (4.8) (range, 6-28). Overall, patients who died had a significantly higher mean (SD) MELD score than did survivors (14.1 [5.4] vs 11.2 [4.6]; P < .001). The MELD score and the injury severity score were statistically significant risk factors that were independently associated with mortality in this group of patients (the area under the curve for the model was 0.944; cumulative R(2) = 0.545). Each unit increase in the MELD score was associated with an 18% increase in the odds for mortality (adjusted odds ratio, 1.18 [95% confidence interval, 1.08-1.29]; P < .001).
The MELD score is a simple objective tool for risk stratification in cirrhotic patients who have sustained injury.
研究终末期肝病模型（MELD）评分预测肝硬化创伤患者死亡风险的能力。尽管肝硬化与受伤后不良预后相关，但肝硬化严重程度对预后的相对影响尚不清楚。MELD评分是一个经过前瞻性开发和验证的评分系统，与慢性肝病患者肝功能障碍严重程度增加及死亡风险相关。
回顾性研究。根据患者入住一级创伤中心时测得的国际标准化比值、血清肌酐水平和血清总胆红素水平，计算每位患者的MELD评分。采用逻辑回归分析评估MELD评分与死亡率的相关性。
一级创伤中心。
2003年1月至2009年12月期间入住一级创伤中心的肝硬化创伤患者。
死亡率。
在7年的研究期间，共收治285例受伤的肝硬化患者。平均（标准差）年龄为50.0（10.5）岁，平均（标准差）MELD评分为11.7（4.8）（范围6 - 28）。总体而言，死亡患者的平均（标准差）MELD评分显著高于存活患者（14.1 [5.4] 对11.2 [4.6]；P <.001）。MELD评分和损伤严重程度评分是该组患者中与死亡率独立相关的统计学显著危险因素（模型曲线下面积为0.944；累积R(2) = 0.545）。MELD评分每增加一个单位，死亡几率增加18%（调整后的优势比为1.18 [95%置信区间，1.08 - 1.29]；P <.001）。
MELD评分是评估肝硬化创伤患者风险分层的简单客观工具。
