Predicting survival among patients listed for liver transplantation: An assessment of serial MELD measurements
Predicting survival among patients listed for liver transplantation: An assessment of serial MELD measurements
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DOI：
10.1111/j.1600-6143.2004.00550.x
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发表时间：
2004-11-01
影响因子：
8.8
通讯作者：
Dickson, ER
中科院分区：
文献类型：
--
作者：
Bambha, K;Kim, WR;Dickson, ER
我们研究了对列入肝移植患者的终末期肝病 (MELD) 测量考虑重复模型是否可以比目前单独使用 MELD 提高预测价值。提取了我们机构 1990 年至 1999 年间列入联合器官共享网络 (UNOS) 的所有成人原发性肝移植候选者的临床数据。血清肌酐、胆红素和国际标准化比值 (INR) 均从机构实验室数据库中获得。使用当前 MELD、MELD 变化（Delta）和 MELD 分数数量构建 Cox 模型来预测等待名单上的生存情况。 861 名患者符合纳入标准，639 名患者接受了移植，80 名患者在等待过程中死亡。当前 MELD 的一个单位增量在所有模型中都会产生从 1.12 到 1.19 不等的显着风险比。 Delta MELD 可单变量预测死亡率，但当包含当前 MELD 时预测性较差，而当考虑当前 MELD 评分和数量时则不能预测。总体而言，当前的 MELD 是候补名单上死亡风险的最重要的决定因素。 Delta MELD 仅可预测事件发生后 4 天内的死亡；然而，这部分与死亡过程本身相关，从而限制了 Delta MELD 在生存预测模型中的效用。
We examined whether consideration of repeated model for end-stage liver disease (MELD) measurements for patients listed for liver transplantation improves predictive value beyond current MELD alone. Clinical data were extracted for all adult primary liver transplantation candidates from our institution who were listed with the United Network for Organ Sharing (UNOS) between 1990 and 1999. Serum creatinine, bilirubin, and international normalized ratio (INR) were obtained from an institutional laboratory database. Cox models were constructed using current MELD, change in MELD (Delta), and number of MELD scores to predict survival on the waiting list. Eight hundred and sixty-one patients met inclusion criteria, 639 underwent transplantation, and 80 died while waiting. A one-unit increment in current MELD imparted significant hazard ratios ranging from 1.12 to 1.19 in all models. Delta MELD was predictive of mortality univariately, but less predictive when current MELD was included, and not predictive when considered with both current and number of MELD scores. Overall, current MELD is the single most important determinant of mortality risk on the waiting list. Delta MELD is predictive of death only within 4 d of the event; however, part of this correlates with the dying process itself, thus limiting Delta MELD's utility in survival prediction models.