Xun Yun-Hao, Shi Jun-Ping, Li Chun-Qing, Li Dan, Shi Wei-Zhen, Pan Qing-Chun, Guo Jian-Chun, Zang Guo-Qing
Department of Liver Diseases, Hangzhou Sixth People's Hospital/Xixi Hospital of Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang 310014, P.R. China.
Department of Infectious Diseases, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, P.R. China.
Mol Med Rep. 2014 May;9(5):1559-68. doi: 10.3892/mmr.2014.1983. Epub 2014 Feb 25.
The present study aimed to compare the short-term prognostic performance of a series of model for end-stage liver disease (MELD) and respective delta (∆) scores scoring systems in a population with acute-on-chronic hepatitis B liver failure (ACHBLF), and to investigate the potential effects from antivirals. A total of 77 patients with ACHBLF of mean age 46 years, 82% male, with 58.4% receiving antivirals, were recruited for this study. The ∆ scores for MELDs were defined as the changes one week after admission. Thirty‑eight (49%) patients (22 treated with antivirals) died within three months. The mean MELD and ∆MELD scores of the survival group were 19.5 ± 4.4 and 0.2 ± 3.7 respectively, and those of the mortality group were 23.5 ± 5.5 and 7.9 ± 6, respectively. The area under the receiver operating characteristic curve (AUC) for MELD, integrated MELD (iMELD), MELD with the addition of serum sodium (MELD-Na), updated MELD (upMELD), MELD excluding the international normalized ratio (INR; MELD-XI), United Kingdom MELD (UKMELD) and their ∆ scores were 0.72, 0.81, 0.77, 0.69, 0.65, 0.77 and 0.86, 0.83, 0.83, 0.82, 0.79 and 0.79, respectively. iMELD and MELD-Na significantly improved the accuracy of MELD (P<0.05). A cut-off value of 41.5 for the iMELD score can prognose 71% of mortalities with a specificity of 85%. In each pair of models, the ∆ score was superior to its counterpart, particularly when applied to patients with MELD ≤ 30. Decreased accuracy was observed for all models in the subset of patients treated with antivirals, although their baseline characteristics were comparable to those of untreated patients, while iMELD, MELD-Na and respective ∆ models remained superior with regard to the predictability. The iMELD and MELD-Na models predicted three-month mortality more accurately, while the ∆ models were superior to their counterparts when MELD ≤ 30; however, their performance was altered by antivirals, and thus requires optimization.
本研究旨在比较一系列终末期肝病模型（MELD）及其相应的差值（∆）评分系统在慢性乙型肝炎急性肝衰竭（ACHBLF）患者中的短期预后评估性能，并研究抗病毒药物的潜在影响。本研究共纳入77例ACHBLF患者，平均年龄46岁，男性占82%，其中58.4%接受了抗病毒治疗。MELD的∆评分定义为入院一周后的变化值。38例（49%）患者（22例接受抗病毒治疗）在三个月内死亡。存活组的平均MELD和∆MELD评分分别为19.5±4.4和0.2±3.7，死亡组分别为23.5±5.5和7.9±6。MELD、综合MELD（iMELD）、加入血清钠的MELD（MELD-Na）、更新的MELD（upMELD）、排除国际标准化比值（INR）的MELD（MELD-XI）、英国MELD（UKMELD）及其∆评分的受试者工作特征曲线下面积（AUC）分别为0.72、0.81、0.77、0.69、0.65、0.77和0.86、0.83、0.83、0.82、0.79和0.79。iMELD和MELD-Na显著提高了MELD的准确性（P<0.05）。iMELD评分的截断值为41.5时，可预测71%的死亡病例，特异性为85%。在每对模型中，∆评分均优于其对应的原评分，尤其适用于MELD≤30的患者。在接受抗病毒治疗的患者亚组中，尽管其基线特征与未治疗患者相当，但所有模型的准确性均有所下降，而iMELD、MELD-Na及其相应的∆模型在预测性方面仍具有优势。iMELD和MELD-Na模型能更准确地预测三个月死亡率，而当MELD≤30时，∆模型优于其对应的原评分；然而，它们的性能会因抗病毒药物而改变，因此需要优化。
