Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Department of Surgery, Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2023 Nov;64(11):647-657. doi: 10.3349/ymj.2023.0163.
The model for end-stage liver disease (MELD) 3.0 has recently been suggested for determining liver allocation. We aimed to apply MELD 3.0 to a Korean population and to discover differences between patients with and without hepatocellular carcinoma (HCC).
This study is a retrospective study of 2203 patients diagnosed with liver cirrhosis at Severance Hospital between 2016-2022. Harrell's concordance index was used to validate the ability of MELD scores to predict 90-day survival.
During a mean follow-up of 12.9 months, 90-day survival was 61.9% in all patients, 50.4% in the HCC patients, and 74.8% in the non-HCC patients. Within the HCC patients, the concordance index for patients on the waitlist was 0.653 using MELD, which increased to 0.753 using MELD 3.0. Among waitlisted patients, the 90-day survival of HCC patients was worse than that of non-HCC patients with MELD scores of 31-37 only (69.7% vs. 30.0%, =0.001). Applying MELD 3.0, the 90-day survival of HCC patients was worse than that of non-HCC patients across a wider range of MELD 3.0 scores, compared to MELD, with MELD 3.0 scores of 21-30 and 31-37 (82.0% vs. 72.5% and 72.3% vs. 24.3%, =0.02 and <0.001, respectively).
MELD 3.0 predicted 90-day survival of the HCC patients more accurately than original MELD score; however, the disparity between HCC and non-HCC patients increased, particularly in patients with MELD scores of 21-30. Therefore, a novel exception score is needed or the current exception score system should be modified.
终末期肝病模型（MELD）3.0 最近被建议用于确定肝脏分配。我们旨在将 MELD 3.0 应用于韩国人群，并发现患有和不患有肝细胞癌（HCC）的患者之间的差异。
本研究是对 2016 年至 2022 年期间在 Severance 医院诊断为肝硬化的 2203 名患者进行的回顾性研究。哈雷尔一致性指数用于验证 MELD 评分预测 90 天生存率的能力。
在平均 12.9 个月的随访中，所有患者的 90 天生存率为 61.9%，HCC 患者为 50.4%，非 HCC 患者为 74.8%。在 HCC 患者中，使用 MELD 时候补名单上患者的一致性指数为 0.653，使用 MELD 3.0 时增加到 0.753。在候补名单上的患者中，只有 MELD 评分在 31-37 分的 HCC 患者的 90 天生存率比非 HCC 患者差（69.7%比 30.0%，=0.001）。应用 MELD 3.0 时，与 MELD 相比，HCC 患者的 90 天生存率在更广泛的 MELD 3.0 评分范围内比非 HCC 患者差，MELD 3.0 评分在 21-30 分和 31-37 分（82.0%比 72.5%和 72.3%比 24.3%，=0.02 和<0.001）。
MELD 3.0 比原始 MELD 评分更准确地预测 HCC 患者的 90 天生存率；然而，HCC 和非 HCC 患者之间的差距增加，特别是在 MELD 评分在 21-30 分的患者中。因此，需要一个新的例外评分，或者应该修改当前的例外评分系统。
