Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
PLoS One. 2013 Dec 12;8(12):e80661. doi: 10.1371/journal.pone.0080661. eCollection 2013.
The model for end-stage liver disease (MELD) score is used to stratify candidates for liver transplantation based on objective measures of disease severity. MELD has been validated as a predictor of wait-list mortality in transplantation candidates and has been postulated as a predictor of post-transplant survival. The purpose of this study was to examine the predictive value of the pre-transplantation MELD score on post-transplant survival from relevant existing studies. A systematic review and critical appraisal was performed using Cochrane guidelines. PubMed, the Cochrane Library, Embase, and Web of Science were searched for articles published in the English language since 2005 using a structured search strategy. There were 3058 discrete citations identified and screened for possible inclusion. Any study examining the relationship between pre-transplant MELD and post-transplant survival in the general transplant population was included. Thirty-seven studies met these criteria and were included in the review. Studies were all case series that typically involved stratified analyses of survival by MELD. They represented 15 countries and a total of 53,691 patients. There was significant clinical heterogeneity in patient populations across studies, which precluded performance of a meta-analysis. In 15 studies, no statistically significant association between MELD and post-transplant survival was found. In the remaining 22, some association was found. Eleven studies also measured predictive ability with c-statistics. Values were below 0.7 in all but two studies, suggesting poor predictive value. In summary, while the majority of studies reported an association between pre-transplantation MELD score and post-transplant survival, they represented a low level of evidence. Therefore, their findings should be interpreted conservatively.
终末期肝病模型（MELD）评分用于根据疾病严重程度的客观指标对肝移植候选者进行分层。MELD 已被验证为移植候选者等待名单死亡率的预测因子，并被假定为移植后生存的预测因子。本研究旨在通过相关的现有研究检验移植前 MELD 评分对移植后生存的预测价值。使用 Cochrane 指南进行了系统评价和批判性评价。使用结构化搜索策略，在 PubMed、Cochrane 图书馆、Embase 和 Web of Science 上搜索自 2005 年以来以英文发表的文章。确定了 3058 个离散引文并进行了可能纳入的筛选。纳入了任何研究，这些研究都检查了一般移植人群中移植前 MELD 与移植后生存之间的关系。符合这些标准的 37 项研究被纳入综述。这些研究都是病例系列，通常涉及按 MELD 分层分析生存情况。它们代表了 15 个国家和总共 53691 名患者。研究人群在患者人群方面存在显著的临床异质性，这排除了进行荟萃分析的可能性。在 15 项研究中，未发现 MELD 与移植后生存之间存在统计学显著关联。在其余 22 项研究中，发现了一些关联。有 11 项研究还使用 C 统计量测量了预测能力。除了两项研究外，所有研究的值均低于 0.7，表明预测能力较差。总之，虽然大多数研究报告了移植前 MELD 评分与移植后生存之间存在关联，但它们的证据水平较低。因此，应谨慎解释他们的发现。
