终末期肝病模型（MELD）评分对希腊肝移植的影响。

Impact of the Model for End-stage Liver Disease (MELD) score on liver transplantation in Greece.

作者信息

Karapanagiotou A, Kydona C, Dimitriadis C, Papadopoulos S, Theodoridou T, Tholioti T, Fouzas G, Imvrios G, Gritsi-Gerogianni N

机构信息

Intensive Care Unit "Hippokratio" Hospital, Thessaloniki, Greece.

出版信息

Transplant Proc. 2014 Nov;46(9):3212-5. doi: 10.1016/j.transproceed.2014.10.032.

DOI:10.1016/j.transproceed.2014.10.032

PMID:25420862

Abstract

INTRODUCTION

The impact of preoperative Model for End-stage Liver Disease (MELD) score in postoperative mortality remains unclear. The assumption that patients with a higher MELD score will have a higher mortality rate is not confirmed and studies are contradictory.

AIM

The study of the clinical course of patients with a higher MELD score and its impact in immediate and later mortality in comparison with patients with a lower MELD score in the only liver transplantation center in Greece.

METHOD

We retrospectively studied 71 patients who underwent orthotopic liver transplantation (OLT) in the time period between 1-1-2011 and 31-12-2013. The patients were divided into 2 groups: Group A with a MELD score ≥23 and Group B with a MELD score <23.

RESULTS

In the patients with a MELD score ≥23 the duration of mechanical ventilation and length of stay in the ICU were prolonged (P = .013 and .009, respectively), the transfusions were more (P = .005), and the rates of ICU readmissions (22.5% vs 7.31%, P = .001) and infections (42.5% vs 17.5%, P = .011) were higher. Thirty-day mortality did not differ between the 2 groups (P = .420), but there was a statistically significant difference in morbidity and in 180-day mortality.

CONCLUSION

The patients with a higher MELD score have more complex pathophysiology. This score seems to affect morbidity and late, but not early, mortality.

摘要

引言

终末期肝病模型（MELD）评分对术后死亡率的影响尚不清楚。MELD评分较高的患者死亡率也较高这一假设未得到证实，且各项研究结果相互矛盾。

目的

在希腊唯一的肝移植中心，研究MELD评分较高的患者的临床病程及其对近期和远期死亡率的影响，并与MELD评分较低的患者进行比较。

方法

我们回顾性研究了2011年1月1日至2013年12月31日期间接受原位肝移植（OLT）的71例患者。患者分为两组：A组MELD评分≥23，B组MELD评分<23。

结果

MELD评分≥23的患者机械通气时间和ICU住院时间延长（分别为P = 0.013和0.009），输血次数更多（P = 0.005），ICU再入院率（22.5%对7.31%，P = 0.001）和感染率（42.5%对17.5%，P = 0.011）更高。两组患者的30天死亡率无差异（P = 0.420），但在发病率和180天死亡率方面存在统计学显著差异。