Cardoso N M, Silva T, Basile-Filho A, Mente E D, Castro-e-Silva O
Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
Illinois Institute of Technology, Department of Applied Mathematics, Chicago, Illinois, United States.
Transplant Proc. 2014 Jun;46(5):1407-12. doi: 10.1016/j.transproceed.2013.12.067.
Liver transplantation (OLT) involves a 5% to 10% 30-day mortality rate. Multiple scores have been used as predictors of early postoperative mortality, such as the original Model for End-stage Liver Disease (MELD) and MELD sodium. Investigations have been conducted over the last 5 years to find new predictors of early post-OLT mortality.
The aim of this study was to develop a new mathematical model to predict the individual chance of 30-day mortality after OLT.
The study was conducted on 58 patients submitted to OLT at the University Hospital, between October 2008 and March 2012. The 29 latest survivor and 29 latest nonsurvivor cases were selected. Arterial blood sodium, lactate, international normalized ratio, total bilirubin, and creatinine values were determined 1 hour after the end of surgery. The MELD original equation, MELD sodium, and new MELD lactate were also elaborated. The results were analyzed by the Mann-Whitney and Wilcoxon tests. The level of significance was set at .05.
The new formula elaborated was as follows: MELD lactate = 5.68 × loge (lactate) + 0.64 × (Original MELD) + 2.68. The MELD lactate values were significantly higher than the MELD sodium and original MELD values (P < .05). The area under the receiver operating characteristic curve of MELD lactate in predicting the outcome of patients submitted to OLT was 0.80, as opposed to 0.71 for the original MELD and 0.72 for MELD sodium (P < .05).
The postoperative MELD lactate score proved to be more specific and sensitive than the original MELD and MELD sodium as a predictive model of the outcome of patients submitted to OLT.
肝移植（OLT）的30天死亡率为5%至10%。多种评分已被用作术后早期死亡率的预测指标，如最初的终末期肝病模型（MELD）和MELD钠评分。在过去5年中，人们一直在进行研究以寻找OLT术后早期死亡率的新预测指标。
本研究的目的是开发一种新的数学模型来预测OLT术后30天死亡的个体概率。
该研究对2008年10月至2012年3月期间在大学医院接受OLT的58例患者进行。选取了29例最新的存活者和29例最新的非存活者病例。在手术结束1小时后测定动脉血钠、乳酸、国际标准化比值、总胆红素和肌酐值。还制定了MELD原始方程、MELD钠评分和新的MELD乳酸评分。结果通过曼-惠特尼检验和威尔科克森检验进行分析。显著性水平设定为0.05。
制定的新公式如下：MELD乳酸评分=5.68×ln（乳酸）+0.64×（原始MELD）+2.68。MELD乳酸评分值显著高于MELD钠评分和原始MELD评分值（P<0.05）。MELD乳酸评分在预测OLT患者结局时的受试者工作特征曲线下面积为0.80，而原始MELD评分为0.71，MELD钠评分为0.72（P<0.05）。
作为OLT患者结局的预测模型，术后MELD乳酸评分比原始MELD评分和MELD钠评分更具特异性和敏感性。
