终末期肝病模型（MELD）评分：在非对乙酰氨基酚所致急性肝衰竭中的效用及与国王学院标准的比较

MELD score: utility and comparison with King's College criteria in non-acetaminophen acute liver failure.

作者信息

Parkash Om, Mumtaz Khalid, Hamid Saeed, Ali Shah Syed Hasnain, Wasim Jafri S M

机构信息

Department of Medicine, The Aga Khan University Hospital, Stadium Road, Karachi.

出版信息

J Coll Physicians Surg Pak. 2012 Aug;22(8):492-6.

PMID:22868013

Abstract

OBJECTIVE

To compare Model for End-stage Liver Disease Score (MELD Score, MS) and King's College Hospital (KCH) criteria for finding correlation of mortality in non-acetaminophen induced acute liver failure (NAI-ALF).

STUDY DESIGN

An analytical cross-sectional study.

PLACE AND DURATION OF STUDY

The Aga Khan University Hospital, Karachi, from 2005 to 2007.

METHODOLOGY

The study included patients with NAI-ALF. KCH criteria were labelled as good and bad prognosis groups. MELD score were calculated by using the MELD calculator. ROC was plotted and sensitivity analysis was done. ETA was used to see correlation between MELD and KCH.

RESULTS

Ninety-one patients with mean age of 32.5 + 16.3 years were studied; 49 were males (54%). Out of these, 57 patients died (63%); two leading causes of non-acetaminophen induced acute liver failure (NAI-ALF) were hepatitis hepatitis B virus (HBV) (n = 30, 33%) followed by hepatitis E virus in (n = 23, 25.3%). According to King's College Hospital (KCH) criteria, 50 patients (88%) who died had bad prognosis and 24 patients (70.6%) who survived had good prognosis. The ROC determined MELD score of 32 was the best predictor of mortality with sensitivity and specificity of 79% and 71%, respectively and positive predictive value (PPV) and negative predictive values (NPV) of 82% and 67% respectively. There was significant association between mortality and bad prognosis according to KCH criteria (p < 0.001). Overall mean MELD score (MMS) was 35.35 + 8.64. MMS on admission was 38 + 7.32 in patients who died and 30.7 + 8.77 in those who survived (p = < 0.001). MMS correlated equally with KCH criteria (ETA = 0.52).

CONCLUSION

The admission MELD score has an excellent utility and correlates equally with KCH criteria for mortality in NAI- ALF.

摘要

目的

比较终末期肝病模型评分（MELD评分，MS）和国王学院医院（KCH）标准，以确定非对乙酰氨基酚所致急性肝衰竭（NAI-ALF）患者死亡率的相关性。

研究设计

一项分析性横断面研究。

研究地点及时间

2005年至2007年在卡拉奇的阿迦汗大学医院进行。

方法

该研究纳入了NAI-ALF患者。KCH标准被分为预后良好组和预后不良组。使用MELD计算器计算MELD评分。绘制ROC曲线并进行敏感性分析。使用ETA来观察MELD与KCH之间的相关性。

结果

共研究了91例患者，平均年龄为32.5±16.3岁；其中49例为男性（54%）。在这些患者中，57例死亡（63%）；非对乙酰氨基酚所致急性肝衰竭（NAI-ALF）的两个主要病因是乙型肝炎病毒（HBV）肝炎（n = 30，33%），其次是戊型肝炎病毒（n = 23，25.3%）。根据国王学院医院（KCH）标准，50例死亡患者（88%）预后不良，24例存活患者（70.6%）预后良好。ROC曲线确定MELD评分为32是死亡率的最佳预测指标，敏感性和特异性分别为79%和71%，阳性预测值（PPV）和阴性预测值（NPV）分别为82%和67%。根据KCH标准，死亡率与预后不良之间存在显著关联（p < 0.001）。总体平均MELD评分（MMS）为35.35±8.64。死亡患者入院时的MMS为38±7.32，存活患者为30.7±8.77（p = < 0.001）。MMS与KCH标准的相关性相同（ETA = 0.52）。