Brandão Ajácio Bandeira de Mello, Bombassaro Isadora Zanotelli, Coral Gabriela Perdomo, Soldera Jonathan, Kupski Carlos
Universidade Federal de Ciências da Saúde de Porto Alegre, Faculdade de Medicina, Programa de Pós-Graduação em Medicina: Hepatologia, Porto Alegre, RS, Brasil.
Unidade de Gastroenterologia e Hepatologia, Irmandade da Santa Casa de Porto Alegre, Porto Alegre, RS, Brasil.
Arq Gastroenterol. 2025 Apr 4;62:e24065. doi: 10.1590/S0004-2803.24612024-065. eCollection 2025.
The natural history of cirrhosis is characterized by an asymptomatic phase (compensated cirrhosis) followed by a rapidly progressive phase (decompensated cirrhosis). The ability to predict the survival of patients with cirrhosis is crucial for decision-making, some as complex as the indication for a liver transplant. Several models have been developed and validated.
To analyze and compare the performance of models in predicting 90-day mortality among patients hospitalized with decompensated cirrhosis.
A sample of 481 hospitalized patients, with a mean age of 59.04 years 73% male, diagnosed with decompensated cirrhosis and a mean Child-Pugh score of 9. The prognostic models were calculated based on tests performed on admission: MELD-Na, MELD-Plus, MELD 3.0, ReMELD, Refit MELD, and Refit MELD-Na. The accuracy of the models was assessed by calculating the area under the receiver operating characteristic (AUROC) curve, and their respective 95% confidence intervals. Comparisons between the areas were conducted using the DeLong test. A comparison was conducted among all scores, with a primary focus on MELD 3.0 and MELD-Plus. These specific scores were the focal points of interest.
The scores presented AUROC curve values of 0.703-0.758, indicating a moderate capacity to discriminate between survivors and deceased patients during the considered period. The comparison between the models did not unequivocally establish the superiority of one model over the other.
The scores have a limited predictive ability for death within 90 days in patients with decompensated cirrhosis. Our study is unable to establish the prognostic superiority of a specific scoring system.
• This retrospective, multicenter study evaluated the accuracy of six predictive models of death within 90 days in 461 patients hospitalized for decompensated cirrhosis.
• The scores presented an area under the receiver operating characteristic curve of 0.703-0.758, indicating a good ability to discriminate between survivors and deceased patients during the considered period.
• The comparison between the models did not unequivocally establish the superiority of one model over the other.
肝硬化的自然病程以无症状期（代偿期肝硬化）为特征，随后是快速进展期（失代偿期肝硬化）。预测肝硬化患者生存率的能力对于决策至关重要，有些决策如肝移植指征一样复杂。已经开发并验证了几种模型。
分析和比较各模型预测失代偿期肝硬化住院患者90天死亡率的性能。
选取481例住院患者作为样本，平均年龄59.04岁，男性占73%，诊断为失代偿期肝硬化，平均Child-Pugh评分为9分。根据入院时进行的检查计算预后模型：MELD-Na、MELD-Plus、MELD 3.0、ReMELD、Refit MELD和Refit MELD-Na。通过计算受试者工作特征（AUROC）曲线下面积及其各自的95%置信区间来评估模型的准确性。使用DeLong检验对各面积之间进行比较。对所有评分进行比较，主要关注MELD 3.0和MELD-Plus。这些特定评分是关注的焦点。
各评分的AUROC曲线值为0.703 - 0.758，表明在研究期间区分存活患者和死亡患者的能力中等。模型之间的比较并未明确确定一种模型优于另一种模型。
这些评分对失代偿期肝硬化患者90天内死亡的预测能力有限。我们的研究无法确定特定评分系统的预后优越性。
• 这项回顾性多中心研究评估了461例失代偿期肝硬化住院患者90天内死亡的六种预测模型的准确性。
• 各评分的受试者工作特征曲线下面积为0.703 - 0.758，表明在研究期间区分存活患者和死亡患者的能力良好。
• 模型之间的比较并未明确确定一种模型优于另一种模型。
