终末期肝病模型（MELD）评分对酒精性肝炎患者预后的预测评估
Assessment of the Model for End-stage Liver Disease (MELD) Score in Predicting Prognosis of Patients with Alcoholic Hepatitis.
作者信息
Goyal Sundeep K, Dixit Vinod K, Jain Ashok K, Mohapatra Pradeep K, Ghosh Jayant K
机构信息
Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh 221005, India.
出版信息
J Clin Exp Hepatol. 2014 Mar;4(1):19-24. doi: 10.1016/j.jceh.2014.02.006. Epub 2014 Feb 27.
BACKGROUND
Traditionally, Maddrey discriminant function (DF) score has been used for stratifying the prognosis of alcoholic hepatitis. Recently, the Model for end-stage liver disease (MELD) score has been applied to alcoholic hepatitis and some investigators consider MELD score as a better prognostic indicator. Another new prognostic approach, Lille model has been also suggested to accurately identify patients at high risk of death. Therefore, this prospective study was aimed to compare MELD, DF, Child-Turcotte-Pugh (CTP) scores and Lille model for predicting the short-term mortality in Indian patients with alcoholic hepatitis.
METHODS
We calculated the DF, CTP, MELD and Lille scores in patients hospitalized with alcoholic hepatitis & evaluated if the scores predicted in-hospital mortality.
RESULTS
A total of 104 patients were enrolled and thirty-two (30.7%) patients died during the hospitalization (2-30 days). Admission DF score (OR 1.1, P < 0.04), CTP (OR 2, P < 0.05) MELD score (OR 2.2, P < 0.005) and first week MELD score (OR 1.1, P < 0.05) were independently associated with in-hospital mortality. The area under the receiver-operating curve (AUROC) for the admission and day 7 MELD score was significantly higher than CTP score and was comparable to DF score and Lille model (AUC & 95% CI: 0.97 [0.95-1.0], 0.99 [0.99-1.0], 0.91 [0.83-0.91] and 0.92 [0.86-0.98] for MELD at admission & day 7, admission DF and Lille model, respectively). The MELD score >14 at admission and >12 at day 7 had high sensitivity and specificity in predicting short-term mortality (96%, 89% and 95%, 98% respectively). The cutoff of 0.45 for the Lille model was able to identify 79% of the observed deaths, whereas DF score ≥32 for DF were able to identify 85%.
CONCLUSION
MELD score, as a predictive model for assessment of short-term mortality in alcoholic hepatitis is better than CTP and comparable to DF and Lille model.
背景
传统上，马德雷判别函数（DF）评分一直用于对酒精性肝炎的预后进行分层。最近，终末期肝病模型（MELD）评分已应用于酒精性肝炎，一些研究者认为MELD评分是更好的预后指标。另一种新的预后评估方法，里尔模型也被提出用于准确识别高死亡风险患者。因此，本前瞻性研究旨在比较MELD、DF、Child-Turcotte-Pugh（CTP）评分和里尔模型对印度酒精性肝炎患者短期死亡率的预测情况。
方法
我们计算了因酒精性肝炎住院患者的DF、CTP、MELD和里尔评分，并评估这些评分是否能预测住院死亡率。
结果
共纳入104例患者，32例（30.7%）患者在住院期间（2 - 30天）死亡。入院时DF评分（比值比1.1，P < 0.04）、CTP评分（比值比2，P < 0.05）、MELD评分（比值比2.2，P < 0.005）以及第1周MELD评分（比值比1.1，P < 0.05）均与住院死亡率独立相关。入院时及第7天MELD评分的受试者工作特征曲线下面积（AUROC）显著高于CTP评分，与DF评分和里尔模型相当（入院时及第7天MELD评分、入院DF评分和里尔模型的AUC及95%可信区间分别为：0.97 [0.95 - 1.0]、0.99 [0.99 - 1.0]、0.91 [0.83 - 0.91]和0.92 [0.86 - 0.98]）。入院时MELD评分>14及第7天>12对短期死亡率的预测具有较高的敏感性和特异性（分别为96%、89%和95%、98%）。里尔模型的截断值为0.45时能够识别79%的观察到的死亡病例，而DF评分≥32时能够识别85%。
结论
MELD评分作为评估酒精性肝炎短期死亡率的预测模型，优于CTP评分，与DF评分和里尔模型相当。
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