Zhang Q-K, Wang M-L
General Surgical Center, Beijing You-An Hospital, Capital Medical University, Beijing, China.
General Surgical Center, Beijing You-An Hospital, Capital Medical University, Beijing, China.
Transplant Proc. 2019 Apr;51(3):833-841. doi: 10.1016/j.transproceed.2019.01.027. Epub 2019 Jan 9.
Preoperative evaluation is extremely important for patients undergoing liver transplantation (LT) for acute-on-chronic liver failure (ACLF). It is unclear that whether preoperative Model for End-Stage Liver Disease-Serum Sodium (MELD-Na) score has a decisive effect on the complication grade after LF for ACLF. This study is aimed to explore the value of preoperative MELD-Na scores in predicting complication severity grades post LT for ACLF.
One hundred fifty-nine patients enrolled in the study who underwent LT for ACLF between August 1, 2004, and September 1, 2014, were retrospectively analyzed. The Accordion Severity Grading system was adopted to classify the complication severity grade post LT: Grade 1 (mild), grade 2 (moderate), grades 3-5 (severe), and grade 6 (death). The area under the curve was calculated by plotting the receiver operating characteristic curve for evaluating the diagnostic accuracy of MELD-Na score for severe grade and mortality after LT. The correlation between MELD-Na score with complication severity grade post LT was demonstrated by Spearman correlation and multivariate analysis. The MELD-Na based nomogram was constructed to predict short-term mortality (grade 6).
The incidences of postoperative complications at all grade levels were: grade 2: 43 patients (27.0%, MELD-Na 27.3 ± 7.4), grade 3: 41 patients (25.8%, MELD-Na 32.7 ± 12.4), grade 4: 31 patients (19.5%, MELD-Na 34.3 ± 12.1), grade 5: 9 patients (5.7%, MELD-Na 30.7 ± 12.3), grade 6: 35 patients (22%, MELD-Na 37.1 ± 10.4). There was no grade 1 patient. The area under the curve of the MELD-Na scores for severe and death group were 0.631 (P < .05, 95% confidence interval [CI], 0.533-0.728) and 0.670 (P < .05, 95% CI, 0.574-0.766) respectively. The MELD-Na score was significantly correlated with the Accordion Severity Grade (rho 0.297, P < .01) by Spearman correlation analysis. Multivariate analysis confirmed that a MELD-Na score ≥ 25 was the only risk factor for postoperative severe grade complications (P < .05, odds ratio = 4.35) and that MELD-Na ≥ 35 was one risk factor for postoperative mortality (P < .01, hazard ratio = 4.72). MELD-Na ≥ 35 combined with other parameters (female, age, systematic infection, and intraoperative placement of the T-tube) in a constructed nomogram model had a good calibration curve with C-concordance of 0.790.
MELD-Na scores are significantly correlated with Accordion Severity Grades. It can effectively predict the complication severity grade after LT for ACLF.
术前评估对于因慢加急性肝衰竭（ACLF）接受肝移植（LT）的患者极为重要。术前终末期肝病模型-血清钠（MELD-Na）评分对ACLF患者LT术后并发症分级是否具有决定性作用尚不清楚。本研究旨在探讨术前MELD-Na评分在预测ACLF患者LT术后并发症严重程度分级中的价值。
回顾性分析2004年8月1日至2014年9月1日期间因ACLF接受LT的159例患者。采用手风琴严重程度分级系统对LT术后并发症严重程度进行分级：1级（轻度）、2级（中度）、3 - 5级（重度）和6级（死亡）。通过绘制受试者工作特征曲线计算曲线下面积，以评估MELD-Na评分对LT术后重度分级和死亡率的诊断准确性。采用Spearman相关性分析和多因素分析来证明MELD-Na评分与LT术后并发症严重程度分级之间的相关性。构建基于MELD-Na的列线图以预测短期死亡率（6级）。
各级术后并发症发生率分别为：2级：43例（27.0%，MELD-Na 27.3±7.4），3级：41例（25.8%，MELD-Na 32.7±12.4），4级：31例（19.5%，MELD-Na 34.3±12.1），5级：9例（5.7%，MELD-Na 30.7±12.3），6级：35例（22%，MELD-Na 37.1±10.4）。无1级患者。重度和死亡组MELD-Na评分的曲线下面积分别为0.631（P <.05，95%置信区间[CI]，0.533 - 0.728）和0.670（P <.05，95% CI，0.57,4 - 0.766）。Spearman相关性分析显示MELD-Na评分与手风琴严重程度分级显著相关（rho 0.297，P <.01）。多因素分析证实，MELD-Na评分≥25是术后重度并发症的唯一危险因素（P <.05，比值比 = 4.35），MELD-Na≥35是术后死亡的危险因素之一（P <.01，风险比 = 4.72）。在构建的列线图模型中，MELD-Na≥35与其他参数（女性､年龄､全身感染和术中放置T管）相结合，具有良好的校准曲线，C一致性为0.790。
MELD-Na评分与手风琴严重程度分级显著相关。它可以有效预测ACLF患者LT术后并发症的严重程度分级。
