MELD accurately predicts mortality in patients with alcoholic hepatitis
MELD accurately predicts mortality in patients with alcoholic hepatitis
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DOI：
10.1002/hep.20503
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发表时间：
2005-02-01
期刊：
影响因子：
13.5
通讯作者：
Shah, V
中科院分区：
文献类型：
--
作者：
Dunn, W;Jamil, LH;Shah, V
评估酒精性肝炎(AH)患者的病情严重程度有助于预测死亡率，指导治疗决策，并为治疗试验对患者进行分层。用于此目的的传统疾病特异性预后模型是Maddrey判别函数(DF)。终末期肝病模型(MELD)是最近开发的一种评分系统，已被验证为肝移植候选者患者生存的独立预测因子。本研究的目的是检验MELD预测急性肝炎患者死亡率的能力。在明尼苏达州罗切斯特市的梅奥诊所进行了一项回顾性队列研究，研究对象为1995-2001年间被诊断为急性肝炎的73名患者。MELD是AH患者死亡率的唯一独立预测因子。MELD和DF对30天和90天死亡率的预测相似(c-统计和95%CI分别为0.83[0.71-0.96]和0.74[0.62-0.87]，均不显著)和90天死亡率(c-统计和95%CI分别为0.86[0.77-0.96]和0.83[0.74-0.92]，均不显著)。MELD评分21分预测急性肝炎患者90天死亡率的敏感性和特异性分别为75%和75%。综上所述，MELD对于预测急性肝炎患者30天和90天的死亡率是有用的，并且在预测这些患者的死亡率方面保持了比DF更多的实用和统计学优势。MELD是一种有用的临床工具，可用于评估AH患者的死亡率和指导治疗决策，特别是合并腹水和/或脑病的患者。
Assessing severity of disease in patients with alcoholic hepatitis (AH) is useful for predicting mortality, guiding treatment decisions, and stratifying patients for therapeutic trials. The traditional disease-specific prognostic model used for this purpose is the Maddrey discriminant function (DF). The model for end-stage liver disease (MELD) is a more recently developed scoring system that has been validated as an independent predictor of patient survival in candidates for liver transplantation. The aim of the present study was to examine the ability of MELD to predict mortality in patients with AH. A retrospective cohort study of 73 patients diagnosed with AH between 1995 and 2001 was performed at the Mayo Clinic in Rochester, Minnesota. MELD was the only independent predictor of mortality in patients with AH. MELD was comparable to DF in predicting 30-day mortality (c-statistic and 95% CI: 0.83 [0.71-0.96] and 0.74 [0.62-0.87] for MELD and DF, respectively, not significant) and 90-day mortality (c-statistic and 95% CI: 0.86 [0.77-0.96] and 0.83 [0.74-0.92] for MELD and DF, respectively, not significant). A MELD score of 21 had a sensitivity of 75% and a specificity of 75% in predicting 90-day mortality in AH. In conclusion, MELD is useful for predicting 30-day and 90-day mortality in patients with AH and maintains some practical and statistical advantages over DF in predicting mortality rate in these patients. MELD is a useful clinical tool for gauging mortality and guiding treatment decisions in patients with AH, particularly those complicated by ascites and/or encephalopathy.