MELD 或 Sodium MELD：两种评分系统预测经颈静脉肝内门体分流术放置后结局的能力比较。
MELD or Sodium MELD: A Comparison of the Ability of Two Scoring Systems to Predict Outcomes After Transjugular Intrahepatic Portosystemic Shunt Placement.
机构信息
Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455.
Department of Internal Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN.
出版信息
AJR Am J Roentgenol. 2020 Jul;215(1):215-222. doi: 10.2214/AJR.19.21726. Epub 2020 May 20.
The purpose of this study was to compare the ability of the model for end-stage liver disease (MELD) and sodium MELD (MELD-Na) scoring systems to predict outcomes after transjugular intrahepatic portosystemic shunt (TIPS) placement. Two hundred and nineteen consecutive patients who underwent TIPS placement were retrospectively reviewed. The primary outcomes were death within 30 days and 90 days after TIPS placement (30- and 90-day mortality, respectively), and secondary outcomes included death within 365 days after TIPS placement (365-day mortality), length of hospital stay, and readmission to the hospital within 30 days of TIPS placement. Mortality rates within 30, 90, and 365 days after TIPS placement were 2.3% (5/219), 8.2% (17/207), and 21.7% (41/189), respectively. Logistic regression showed that the MELD score predicted 30-day mortality (odds ratio [OR], 1.13; 95% CI, 1.00-1.27; = 0.04) and trended toward predicting 90-day mortality (OR, 1.09; 95% CI, 1.00-1.18; = 0.06), whereas the MELD-Na score did not predict 30-day mortality (OR, 1.02; 95% CI, 0.97-1.06; = 0.51) or 90-day mortality (OR, 1.01; 95% CI, 0.98-1.15; = 0.44). In a comparison of the ROC AUCs for MELD and MELD-Na, MELD showed improved prediction of 30-day mortality ( = 0.06) but did not significantly vary in prediction of 90- and 365-day mortality ( = 0.80 and = 0.76, respectively). When the maximal inflection point for MELD and MELD-Na was analyzed on the basis of 90-day mortality, a score of 23 was found to be most significant for both MELD (OR, 6.6; 95% CI, 1.5-29.1; = 0.01) and MELD-Na (OR, 3.3; 95% CI, 1.1-9.6; = 0.03). MELD and MELD-Na both accurately predicted the length of hospital stay after TIPS placement ( = 0.005 and = 0.01, respectively). MELD is superior to MELD-Na for predicting 30-day and, perhaps, 90-day mortality after TIPS placement. At present, decisions regarding patient selection for TIPS placement should be made on the basis of the MELD score rather than the MELD-Na score.
本研究旨在比较终末期肝病模型（MELD）和钠 MELD（MELD-Na）评分系统预测经颈静脉肝内门体分流术（TIPS）后结局的能力。回顾性分析了 219 例连续接受 TIPS 治疗的患者。主要结局为 TIPS 治疗后 30 天和 90 天内死亡（分别为 30 天和 90 天死亡率），次要结局包括 TIPS 治疗后 365 天内死亡（365 天死亡率）、住院时间和 TIPS 治疗后 30 天内再次入院。TIPS 治疗后 30、90 和 365 天的死亡率分别为 2.3%（5/219）、8.2%（17/207）和 21.7%（41/189）。Logistic 回归显示，MELD 评分预测 30 天死亡率（比值比[OR]，1.13；95%CI，1.00-1.27；P=0.04），且倾向于预测 90 天死亡率（OR，1.09；95%CI，1.00-1.18；P=0.06），而 MELD-Na 评分不能预测 30 天死亡率（OR，1.02；95%CI，0.97-1.06；P=0.51）或 90 天死亡率（OR，1.01；95%CI，0.98-1.15；P=0.44）。在比较 MELD 和 MELD-Na 的 ROC AUC 时，MELD 对 30 天死亡率的预测有所改善（P=0.06），但对 90 天和 365 天死亡率的预测差异无统计学意义（P=0.80 和 P=0.76）。当根据 90 天死亡率分析 MELD 和 MELD-Na 的最大拐点时，发现 MELD 的 23 分和 MELD-Na 的 19 分是预测 90 天死亡率的最佳临界点（MELD：OR，6.6；95%CI，1.5-29.1；P=0.01；MELD-Na：OR，3.3；95%CI，1.1-9.6；P=0.03）。MELD 和 MELD-Na 均可准确预测 TIPS 后住院时间（P=0.005 和 P=0.01）。MELD 优于 MELD-Na 预测 TIPS 后 30 天和可能 90 天死亡率。目前，关于 TIPS 治疗患者选择的决策应基于 MELD 评分，而不是 MELD-Na 评分。
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