评估终末期肝病模型3.0评分在预测肝硬化急性静脉曲张出血患者死亡率中的预后价值。

EVALUATING THE PROGNOSTIC VALUE OF THE MELD 3.0 SCORE IN PREDICTING MORTALITY IN CIRRHOSIS PATIENTS WITH ACUTE VARICEAL BLEEDING.

作者信息

Que Nguyen Pham Tram, Vo Thong Duy

机构信息

Department of Gastroenterology, University Medical Center Ho Chi Minh City, Vietnam.

Department of Internal Medicine, School of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.

出版信息

Clin Transl Gastroenterol. 2025 Aug 22. doi: 10.14309/ctg.0000000000000909.

DOI:10.14309/ctg.0000000000000909

PMID:40844517

Abstract

INTRODUCTION

Acute variceal bleeding (AVB) is a severe complication of cirrhosis, with a 6-week mortality rate of up to 15-20%. Early risk prediction is essential for guiding management. MELD 3.0, a refined version of the original MELD score, incorporates additional variables (gender, sodium, albumin, capped creatinine) to improve short-term mortality prediction. This study assessed MELD 3.0's utility in predicting 6-week mortality in cirrhotic patients with AVB, in comparison with MELD, Glasgow-Blatchford Score (GBS), and AIMS65.

METHODS

A prospective cohort of cirrhotic patients with AVB admitted to Cho Ray Hospital (Nov 2023-May 2024) was studied. The primary outcome was 6-week mortality; in-hospital mortality was secondary. The predictive performance of MELD 3.0, MELD, GBS, and AIMS65 was evaluated using AUCROC.

RESULTS

Among 212 patients, in-hospital and 6-week mortality rates were 4.7% and 19.8%, respectively. For in-hospital mortality, MELD 3.0 showed the highest AUC (0.88), followed by MELD (0.80), AIMS65 (0.74), and GBS (0.59). For 6-week mortality, MELD 3.0 again outperformed others (AUC: 0.81), vs. MELD (0.75), AIMS65 (0.66), and GBS (0.61) (all p < 0.05). A MELD 3.0 cut-off ≥ 20 predicted >25% 6-week mortality (sensitivity 69.1%, specificity 83.5%).

CONCLUSION

MELD 3.0 is a strong predictor of early mortality in cirrhotic patients with AVB. A cut-off ≥ 20 may help identify high-risk patients requiring prompt intensive care.

摘要

引言

急性静脉曲张出血（AVB）是肝硬化的一种严重并发症，6周死亡率高达15%-20%。早期风险预测对于指导治疗至关重要。MELD 3.0是原始MELD评分的改进版本，纳入了额外变量（性别、钠、白蛋白、校正肌酐）以改善短期死亡率预测。本研究评估了MELD 3.0在预测肝硬化合并AVB患者6周死亡率方面的效用，并与MELD、格拉斯哥-布拉奇福德评分（GBS）和AIMS65进行比较。

方法

对2023年11月至2024年5月在朱莱医院收治的肝硬化合并AVB患者的前瞻性队列进行研究。主要结局是6周死亡率；住院死亡率为次要结局。使用AUCROC评估MELD 3.0、MELD、GBS和AIMS65的预测性能。

结果

212例患者中，住院死亡率和6周死亡率分别为4.7%和19.8%。对于住院死亡率，MELD 3.0的AUC最高（0.88），其次是MELD（0.80）、AIMS65（0.74）和GBS（0.59）。对于6周死亡率，MELD 3.0再次优于其他指标（AUC：0.81），而MELD为（0.75）、AIMS65为（0.66）、GBS为（0.61）（所有p<0.05）。MELD 3.0截断值≥20预测6周死亡率>25%（敏感性69.1%，特异性83.5%）。