门静脉血栓形成会损害肝硬化患者的终末期肝病模型（MELD）和终末期肝病模型钠（MELD-Na）评分的效能。

Portal vein thrombosis compromises the performance of MELD and MELD-Na scores in patients with cirrhosis.

作者信息

Ouyang Renjie, Li Hai, Tan Wenting, Wang Xianbo, Zheng Xin, Huang Yan, Meng Zhongji, Gao Yanhang, Qian Zhiping, Liu Feng, Lu Xiaobo, Shi Yu, Shang Jia, Liu Junping, Deng Guohong, Zheng Yubao, Yan Huadong, Jiang Xiuhua, Zhang Yan, Qiao Liang, Zhou Yi, Hou Yixin, Xiong Yan, Chen Jun, Luo Sen, Gao Na, Ji Liujuan, Li Jing, Zheng Rongjiong, Ren Haotang, Wang Haiyu, Zhong Guotao, Li Beiling, Chen Jinjun

机构信息

Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.

Department of Hepatology, Chenzhou No.1 People's Hospital, Chenzhou, China.

出版信息

J Gastroenterol Hepatol. 2023 Jan;38(1):129-137. doi: 10.1111/jgh.16053. Epub 2022 Nov 25.

DOI:10.1111/jgh.16053

PMID:36345143

Abstract

BACKGROUND AND AIMS

The accuracy of model for end-stage liver disease (MELD) and MELD with sodium (MELD-Na) scores in reflecting the clinical outcomes of patients with cirrhosis and portal vein thrombosis (PVT) remains unclear. This study aimed to evaluate the performance of scores in predicting 90-day mortality in patients with cirrhosis and PVT.

METHODS

Post hoc analysis was performed in two prospective cohorts (NCT02457637 and NCT03641872). The correlation between the MELD/MELD-Na score and 90-day liver transplantation (LT)-free mortality was investigated in patients with cirrhosis with and without PVT.

RESULTS

In this study, 2826 patients with cirrhosis were included, and 255 (9.02%) had PVT. The cumulative incidence of 90-day LT-free mortality did not significantly differ between patients with and without PVT (log-rank P = 0.0854). MELD [area under the receiver operating curve (AUROC), 0.649 vs. 0.842; P = 0.0036] and MELD-Na scores (AUROC, 0.691 vs. 0.851; P = 0.0108) were compared in patients with and without PVT, regarding the prediction of 90-day LT-free mortality. In MELD < 15 and MELD-Na < 20 subgroups, patients with PVT had a higher 90-day LT-free mortality than those without PVT (7.91% vs. 2.64%, log-rank P = 0.0011; 7.14% vs. 3.43%, log-rank P = 0.0223), whereas in MELD ≥ 15 and MELD-Na ≥ 20 subgroups, no significant difference was observed between patients with and without PVT.

CONCLUSIONS

The performance of MELD and MELD-Na scores in predicting 90-day LT-free mortality of patients with cirrhosis was compromised by PVT. MELD < 15 or MELD-Na < 20 may underestimate the 90-day LT-free mortality in patients with PVT.

摘要

背景与目的

终末期肝病模型（MELD）及含钠终末期肝病模型（MELD-Na）评分在反映肝硬化合并门静脉血栓形成（PVT）患者临床结局方面的准确性尚不清楚。本研究旨在评估这些评分对肝硬化合并PVT患者90天死亡率的预测性能。

方法

对两个前瞻性队列（NCT02457637和NCT03641872）进行事后分析。研究了有和无PVT的肝硬化患者中MELD/MELD-Na评分与90天无肝移植死亡率之间的相关性。

结果

本研究纳入了2826例肝硬化患者，其中255例（9.02%）有PVT。有和无PVT患者的90天无肝移植死亡率累积发生率无显著差异（对数秩检验P = 0.0854）。在预测90天无肝移植死亡率方面，对有和无PVT的患者比较了MELD[受试者工作特征曲线下面积（AUROC），0.649对0.842；P = 0.0036]和MELD-Na评分（AUROC，0.691对0.851；P = 0.0108）。在MELD<15和MELD-Na<20亚组中，有PVT的患者90天无肝移植死亡率高于无PVT的患者（7.91%对2.64%，对数秩检验P = 0.0011；7.14%对3.43%，对数秩检验P = 0.0223），而在MELD≥15和MELD-Na≥20亚组中，有和无PVT的患者之间未观察到显著差异。