Zheng Yi-Xiang, Zhong Xiao, Li Ya-Jun, Fan Xue-Gong
Department of Infectious Diseases, Key Laboratory of Viral Hepatitis of Hunan, Xiangya Hospital, Central South University, Changsha, China.
J Gastroenterol Hepatol. 2017 Oct;32(10):1668-1678. doi: 10.1111/jgh.13786.
Acute-on-chronic liver failure (ACLF) has characteristic feature of multisystem organ failure, rapid progression, and low early transplant-free survival. We performed a meta-analysis to determine the accuracy of five scoring systems in predicting mortality of ACLF patients.
A systematic database search was performed, and retrieved articles were graded according to methodological quality. Collated data was meta-analyzed by hierarchical summarized receiver operating characteristic model and bivariate model to evaluate the diagnostic accuracy of scoring systems.
Of 4223 studies identified, 26 studies involving 4732 ACLF patients were included. The model of end-stage liver disease (MELD) score was found to have largest the area under summarized receiver operating characteristic (AUROC) (0.82) compared with other estimated scoring systems, especially for 3-month mortality. MELD serum sodium (MELD-Na) score showed homologous high accuracy, with the AUROC was 0.81. However, meta-analyses of 16 studies showed that Child-Pugh-Turcotte score had least AUROC (0.71). Sequential organ failure assessment (SOFA) score presented moderately lower diagnostic accuracy, with AUROC being 0.73. Moreover, chronic liver failure-SOFA score presented excellent accuracy of prognostication with highest diagnostic odds ratios.
This review demonstrated that MELD had moderate diagnostic accuracy to predict mortality of ACLF patients. Considering the expectative diagnostic value, chronic liver failure-SOFA could be regarded as a promising replacement of MELD. To improve the predictive power of scoring systems, multicenter prospective studies of large sample sizes with long-term follow-up are needed.
慢加急性肝衰竭（ACLF）具有多系统器官衰竭、进展迅速和早期无移植生存率低的特点。我们进行了一项荟萃分析，以确定五种评分系统预测ACLF患者死亡率的准确性。
进行系统的数据库检索，并根据方法学质量对检索到的文章进行分级。通过分层汇总的受试者工作特征模型和双变量模型对整理后的数据进行荟萃分析，以评估评分系统的诊断准确性。
在检索到的4223项研究中，纳入了26项研究，涉及4732例ACLF患者。与其他估计的评分系统相比，终末期肝病模型（MELD）评分的汇总受试者工作特征曲线下面积（AUROC）最大（0.82），尤其是对于3个月死亡率的预测。MELD血清钠（MELD-Na）评分显示出同样高的准确性，AUROC为0.81。然而，对16项研究的荟萃分析表明，Child-Pugh-Turcotte评分的AUROC最小（0.71）。序贯器官衰竭评估（SOFA）评分的诊断准确性略低，AUROC为0.73。此外，慢性肝衰竭-SOFA评分具有出色的预后准确性，诊断比值比最高。
本综述表明，MELD在预测ACLF患者死亡率方面具有中等诊断准确性。考虑到预期的诊断价值，慢性肝衰竭-SOFA可被视为MELD的有前景的替代指标。为提高评分系统的预测能力，需要进行大样本量、长期随访的多中心前瞻性研究。
