He Wei-ping, Hu Jin-hua, Tong Jing-jing, Liu Fang-fang, Wang Hui-fen
Liver Disease Centre for Military Staff, No. 302 Hospital of PLA, Beijing 100039, China.
Zhonghua Yi Xue Za Zhi. 2011 May 10;91(17):1173-7.
To evaluate the short-term prognostic values for the model of end-stage liver disease-sodium (MELD-Na), end-stage liver disease sodium (MELDNa) and their dynamic changes in patients with acute-on-chronic hepatitis B liver failure (ACLF-HBV).
A total of 172 patients diagnosed with ACLF-HBV, admitted between January 2007 to February 2009 and hospitalized for over 2 weeks, were retrospectively recruited. The predictive accuracy of MELD-Na, MELDNa and their dynamic change (Δ) was compared by the method of the area under the receiver operating characteristic curve.
The 3-month mortality rate was 43.6%. The largest concordance (c) statistic predicting 3-month mortality was MELDNa score after a 2-week treatment (0.790), followed by MELD-Na (0.728) score, ΔMELDNa (0.713) and ΔMELD-Na (0.646). The average MELD-Na, MELDNa scores after a 2-week treatment and ΔMELD-Na, ΔMELDNa of survival group were 27.7 ± 8.9, 25.9 ± 5.0, -2.1 ± 10.0 and -1.9 ± 4.2 while those of dead group 34.6 ± 8.7, 31.5 ± 5.0, 2.4 ± 10.3 and 2.4 ± 10.3. There was significant difference in MELD-Na, MELDNa, ΔMELD-Na and ΔMELDNa between two groups. The 3-month mortality of the MELD-Na scores group < 25, 25 - 30, 30 - 35 and > 35 were 18.9%, 37.8%, 57.6% and 65.3% while the MELDNa scores group 14.6%, 33.3%, 72.5% and 84.2% respectively. There was significant difference in the 3-month mortality between four groups. The 3-month mortality of the ΔMELD-Na > 0 group was 58.5% while that of the ΔMELD-Na ≤ 0 group 30%; the 3-month mortality of the ΔMELDNa > 0 group was 61.3% while that of the ΔMELDNa ≤ 0 group 29.9%. There was significant difference between two groups.
MELDNa score after a 2-week treatment is a promising and useful predictor for 3-month mortality in ACLF-HBV patients. The predictive value may further improve if in conjunctions with dynamic changes.
评估终末期肝病-钠模型（MELD-Na）、终末期肝病钠（MELDNa）及其动态变化对慢性乙型肝炎急性肝衰竭（ACLF-HBV）患者的短期预后价值。
回顾性纳入2007年1月至2009年2月期间收治的172例诊断为ACLF-HBV且住院时间超过2周的患者。采用受试者工作特征曲线下面积法比较MELD-Na、MELDNa及其动态变化（Δ）的预测准确性。
3个月死亡率为43.6%。预测3个月死亡率的最大一致性（c）统计量为治疗2周后的MELDNa评分（0.790），其次是MELD-Na评分（0.728）、ΔMELDNa（0.713）和ΔMELD-Na（0.646）。生存组治疗2周后的平均MELD-Na、MELDNa评分及ΔMELD-Na、ΔMELDNa分别为27.7±8.9、25.9±5.0、-2.1±10.0和-1.9±4.2，死亡组分别为34.6±8.7、31.5±5.0、2.4±10.3和2.4±10.3。两组间MELD-Na、MELDNa、ΔMELD-Na和ΔMELDNa存在显著差异。MELD-Na评分<25、25-30、30-35和>35组的3个月死亡率分别为18.9%、37.8%、57.6%和65.3%，而MELDNa评分组分别为14.6%、33.3%、72.5%和84.2%。四组间3个月死亡率存在显著差异。ΔMELD-Na>0组的3个月死亡率为58.5%，而ΔMELD-Na≤0组为30%；ΔMELDNa>0组的3个月死亡率为61.3%，而ΔMELDNa≤0组为29.9%。两组间存在显著差异。
治疗2周后的MELDNa评分是预测ACLF-HBV患者3个月死亡率的一个有前景且有用的指标。若结合动态变化，预测价值可能会进一步提高。
