Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Clin Nutr. 2020 Jun;39(6):1885-1892. doi: 10.1016/j.clnu.2019.08.012. Epub 2019 Aug 21.
BACKGROUND & AIMS: The Model for End-stage Liver Diseases (MELD) is widely accepted for prioritizing candidates awaiting liver transplantation (LT). However, MELD scores do not reflect the severity of the nutritional or functional status of patients with cirrhosis.
This retrospective study analyzed data from 173 patients who were waitlisted for LT at our institution between April 2006 and December 2016. By including skeletal muscle mass, muscle quality and visceral adiposity evaluated using plain computed tomography imaging in MELD scores, we developed body composition-MELD (BC-MELD), and investigated its impact on the prediction of mortality among patients awaiting LT.
The equation generated using Cox regression analysis was as follows: BC-MELD = MELD score + 3.59 × low SMI + 5.42 × high IMAC + 2.06 × high VSR. (IMAC, intramuscular adipose tissue content; SMI, skeletal muscle mass index; VSR, visceral-to-subcutaneous adipose tissue area ratio). The median BC-MELD score was 17.4 and the area under the receiver operating characteristic curve (AUC) revealed a cut-off BC-MELD score of 21.4 (AUC = 0.835, P < 0.001, sensitivity 87.5%, specificity 70.7%). Waitlist mortality in patients with high BC-MELD was significantly higher in all tested cohorts (P < 0.001) and among patients with lower conventional MELD scores (<15) (P < 0.001). The discriminatory power was significantly better for BC-MELD than MELD scores (AUC; 0.835 vs. 0.732, P = 0.001 for 3-month, AUC; 0.765 vs. 0.671, P = 0.002 for 6-month, AUC; 0.716 vs. 0.615, P < 0.001 for 12-month, AUC; 0.636 vs. 0.584, P = 0.014 for overall mortality).
BC-MELD is the first to include not only muscularity but also visceral adiposity. It predicted waitlist mortality more accurately than the conventional MELD score. A new allocation system based on BC-MELD might lead to better outcomes for patients with cirrhosis awaiting LT.
终末期肝病模型（MELD）被广泛用于对等待肝移植（LT）的患者进行优先排序。然而，MELD 评分并不能反映肝硬化患者的营养或功能状态的严重程度。
本回顾性研究分析了 2006 年 4 月至 2016 年 12 月期间在我院接受 LT 候补名单的 173 名患者的数据。通过在 MELD 评分中纳入使用普通计算机断层扫描成像评估的骨骼肌量、肌肉质量和内脏脂肪堆积，我们开发了体成分-MELD（BC-MELD），并研究了其对等待 LT 的患者死亡率预测的影响。
使用 Cox 回归分析生成的方程如下：BC-MELD = MELD 评分+3.59×低 SMI+5.42×高 IMAC+2.06×高 VSR。（IMAC，肌肉内脂肪含量；SMI，骨骼肌质量指数；VSR，内脏与皮下脂肪面积比）。BC-MELD 评分中位数为 17.4，受试者工作特征曲线（ROC）下面积显示 21.4 的 BC-MELD 评分切点（AUC=0.835，P<0.001，灵敏度 87.5%，特异性 70.7%）。在所有测试队列中（P<0.001），以及在低传统 MELD 评分患者（<15）中（P<0.001），高 BC-MELD 患者的候补名单死亡率均显著更高。BC-MELD 的区分能力明显优于 MELD 评分（AUC；0.835 比 0.732，P=0.001 用于 3 个月，AUC；0.765 比 0.671，P=0.002 用于 6 个月，AUC；0.716 比 0.615，P<0.001 用于 12 个月，AUC；0.636 比 0.584，P=0.014 用于总体死亡率）。
BC-MELD 是第一个不仅包含肌肉质量，还包含内脏脂肪堆积的评分。它比传统的 MELD 评分更准确地预测候补名单死亡率。基于 BC-MELD 的新分配系统可能会为等待 LT 的肝硬化患者带来更好的结果。
