Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Korea.
Department of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea.
Liver Transpl. 2023 Oct 1;29(10):1029-1040. doi: 10.1097/LVT.0000000000000126. Epub 2023 Mar 20.
Recently, a new predictive model that jointly considers the Model of End-stage Liver Disease (MELD) 3.0 and albumin has been proposed. This study investigated the performance of the MELD 3.0 score in predicting the 3-month survival of East Asian patients with cirrhosis compared with the other MELD-based scores. Validation was performed with the retrospective data of 2153 patients in South Korea who were listed for liver transplantation (LT). Discrimination and calibration analyses were performed using the MELD-based scores as an independent variable. On average, patients had the original MELD score of 18.70 ± 9.65. Alcohol (39.99%) and chronic HBV (38.55%) were the 2 main etiologies. The MELD 3.0 with albumin showed slightly better discrimination [c-index = 0.738, incremental AUC (iAUC) = 0.719] compared with the MELD 3.0 without albumin (c-index = 0.737, iAUC = 0.715), MELD-Na (c-index = 0.730, iAUC = 0.707), or the original MELD (c-index = 0.718, iAUC = 0.687) for predicting 3-month survival but not significantly different compared with prior models. Likewise, in the stratified analysis according to the strata of MELD, although the performance of MELD 3.0 was better throughout all the MELD strata than MELD original, there was no statistical difference in performance. The MELD 3.0 with albumin reclassified 22.61% of cases classified by the original MELD to higher MELD score categories, and there was no significant difference in the reclassification rate between males and females. The predictive power of the MELD-based system is lower in Asian populations than in western countries. Nonetheless, the MELD 3.0 score with albumin was significantly better in predicting the short-term prognosis of East Asian patients on the LT waitlist than the current allocation system, original MELD.
最近，提出了一种新的预测模型，该模型联合考虑了终末期肝病模型（MELD）3.0 和白蛋白。本研究旨在比较 MELD 3.0 评分与其他基于 MELD 的评分在预测东亚肝硬化患者 3 个月生存率方面的性能。使用韩国 2153 名接受肝移植（LT）患者的回顾性数据进行验证。使用 MELD 为自变量进行区分和校准分析。平均而言，患者的原始 MELD 评分为 18.70±9.65。酒精（39.99%）和慢性 HBV（38.55%）是主要的 2 种病因。与无白蛋白的 MELD 3.0（c 指数=0.737，增量 AUC（iAUC）=0.715）、MELD-Na（c 指数=0.730，iAUC=0.707）或原始 MELD（c 指数=0.718，iAUC=0.687）相比，MELD 3.0 联合白蛋白显示出略有改善的区分能力（c 指数=0.738，iAUC=0.719），但差异无统计学意义。同样，在根据 MELD 分层的分层分析中，尽管 MELD 3.0 在所有 MELD 分层中的性能均优于原始 MELD，但在性能方面没有统计学差异。MELD 3.0 联合白蛋白将原始 MELD 分类为更高 MELD 评分类别的病例重新分类 22.61%，且男性和女性之间的重新分类率无显著差异。基于 MELD 的系统在亚洲人群中的预测能力低于西方国家。然而，与现行分配系统和原始 MELD 相比，MELD 3.0 联合白蛋白在预测 LT 候补名单上东亚患者短期预后方面具有显著优势。
