Department of Medicine II-Gastroenterology and Hepatology, Medical University of Innsbruck, Innsbruck, Austria.
Liver Int. 2012 Sep;32(8):1211-6. doi: 10.1111/j.1478-3231.2012.02766.x. Epub 2012 Mar 1.
BACKGROUND/AIMS: The model of end stage liver disease (MELD) includes serum creatinine, which is a poor surrogate marker of renal function in patients with cirrhosis. Especially in women and patients with advanced disease creatinine underestimates true renal function. Our objective was to assess whether or not the substitution of creatinine by cystatin C improves the prognostic performance of the model.
The association between MELD parameters and cystatin C with survival was investigated using a Cox proportional hazards model. A cystatin C-based MELD score was calculated from the results and compared with creatinine-based MELD in terms of discrimination and calibration.
Four hundred and twenty-nine patients were included in the study; 19% died and 12% underwent liver transplantation during a median follow-up of 602 days. In multivariate Cox regression, cystatin C was an independent predictor of 90-day mortality with a hazard ratio of 8.0 (95% CI: 2.2-29.6). The median cystatin C-based MELD was 15, the median creatinine-based MELD was 12. Calibration and discrimination for 3 month and 1 year mortality was similar between the scores (AUC > 0.85 for both scores). Gender differences in cystatin C-based MELD were less pronounced than those in the creatinine-based model, because creatinine but not cystatin C was affected by gender.
Substitution of creatinine by cystatin C does not improve the predictive power of MELD.
背景/目的：终末期肝病模型（MELD）包括血清肌酐，但其在肝硬化患者中是肾功能的一个较差替代标志物。尤其是在女性和疾病晚期患者中，肌酐会低估真实的肾功能。我们的目的是评估用胱抑素 C 替代肌酐是否能改善模型的预后性能。
使用 Cox 比例风险模型研究 MELD 参数和胱抑素 C 与生存之间的关联。根据结果计算基于胱抑素 C 的 MELD 评分，并在区分度和校准度方面与基于肌酐的 MELD 进行比较。
本研究纳入 429 例患者；中位随访 602 天后，19%的患者死亡，12%的患者接受了肝移植。在多变量 Cox 回归中，胱抑素 C 是 90 天死亡率的独立预测因子，风险比为 8.0（95%CI：2.2-29.6）。基于胱抑素 C 的 MELD 的中位数为 15，基于肌酐的 MELD 的中位数为 12。两种评分在 3 个月和 1 年死亡率的校准度和区分度均相似（两个评分的 AUC 均>0.85）。与基于肌酐的模型相比，基于胱抑素 C 的 MELD 中性别差异不太明显，因为性别仅影响肌酐，而不影响胱抑素 C。
用胱抑素 C 替代肌酐并不能提高 MELD 的预测能力。
