Saldaña Ricardo Salinas, Schrem Harald, Barthold Marc, Kaltenborn Alexander
Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany.
Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.
PLoS One. 2017 Jan 27;12(1):e0170499. doi: 10.1371/journal.pone.0170499. eCollection 2017.
Model of end-stage liver disease (MELD)-score and diverse variants are widely used for prognosis on liver transplant waiting-lists.
818 consecutive patients on the liver transplant waiting-list included to calculate the MELD, MESO Index, MELD-Na, UKELD, iMELD, refitMELD, refitMELD-Na, upMELD and PELD-scores. Prognostic abilities for 90-day mortality were investigated applying Receiver-operating-characteristic-curve analysis. Independent risk factors for 90-day mortality were identified with multivariable binary logistic regression modelling. Methodological quality of the underlying development studies was assessed with a systematic assessment tool.
74 patients (9%) died on the liver transplant waiting list within 90 days after listing. All but one scores, refitMELD-Na, had acceptable prognostic performance with areas under the ROC-curves (AUROCs)>0.700. The iMELD performed best (AUROC = 0.798). In pediatric cases, the PELD-score just failed to reach the acceptable threshold with an AUROC = 0.699. All scores reached a mean quality score of 72.3%. Highest quality scores could be achieved by the UKELD and PELD-scores. Studies specifically lack statistical validity and model evaluation.
Inferior quality assessment of prognostic models does not necessarily imply inferior prognostic abilities. The iMELD might be a more reliable tool representing urgency of transplantation than the MELD-score. PELD-score is assumedly not accurate enough to allow graft allocation decision in pediatric liver transplantation.
终末期肝病模型（MELD）评分及其多种变体广泛用于肝移植等待名单上患者的预后评估。
纳入818例连续的肝移植等待名单上的患者，计算其MELD、Meso指数、MELD-Na、英国终末期肝病模型（UKELD）、综合MELD（iMELD）、改良MELD（refitMELD）、改良MELD-Na（refitMELD-Na）、更新MELD（upMELD）和小儿终末期肝病评分（PELD）。应用受试者工作特征曲线分析研究90天死亡率的预测能力。通过多变量二元逻辑回归模型确定90天死亡率的独立危险因素。使用系统评估工具评估基础开发研究的方法学质量。
74例（9%）患者在列入肝移植等待名单后90天内死亡。除refitMELD-Na外，所有评分的受试者工作特征曲线下面积（AUROC）>0.700，预后表现均可接受。iMELD表现最佳（AUROC = 0.798）。在儿科病例中，PELD评分的AUROC = 0.699，刚好未达到可接受阈值。所有评分的平均质量得分为72.3%。UKELD和PELD评分可获得最高质量得分。研究特别缺乏统计有效性和模型评估。
预后模型的质量评估较差并不一定意味着预后能力较差。与MELD评分相比，iMELD可能是更可靠的代表移植紧迫性的工具。PELD评分可能不够准确，无法在小儿肝移植中用于决定移植物分配。
