Early post-transplant survival: Interaction of MELD score and hospitalization status.
Early post-transplant survival: Interaction of MELD score and hospitalization status.
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DOI：
10.1016/j.jhep.2015.03.034
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发表时间：
2015-09
影响因子：
25.7
通讯作者：
Goldberg DS
中科院分区：
文献类型：
--
作者：
Bittermann T;Makar G;Goldberg DS
基于MELD评分的紧急分配优先考虑等待名单死亡风险最高的患者。然而，需要识别出移植后短期死亡风险最大的患者，以优化通过改善移植受者的长期管理而获得的总生存率的潜在收益。关于MELD评分对移植后早期死亡率的预测能力的数据有限，也没有数据评估MELD评分与住院状态之间的相互作用。我们分析了2002-2013年50，838例非状态1单器官肝移植受者的UNOS数据，并拟合多变量logistic模型，以评估MELD评分和移植前住院状态与移植后短期死亡率之间的关联和相互作用。在多变量logistic模型中，实验室MELD评分和住院状态对移植后3个月、6个月和12个月死亡率有显著的相互作用（p<0.01）。这种相互作用在从ICU移植的实验室MELD评分<25的患者中最为明显，其校正的预测移植后3个月、6个月和12个月死亡率接近MELD评分≥30的患者。与MELD评分为30-34的住院患者相比，ICU中MELD评分≥35的患者3个月的风险显著增加，（OR：1.54，95%CI：1.21-1.97）、6个月（OR：1.35，95%CI：1.09-1.67）和12个月（OR：1.25，95%CI：1.03-1.52）移植后死亡率。移植前ICU状态改变了移植后早期死亡的风险，与MELD评分无关。在确定移植候选人时应考虑这一点，以优化稀缺资源的有效利用。
Urgency-based allocation that relies on the MELD score prioritizes patients at the highest risk of waitlist mortality. However, identifying patients at greatest risk for short-term post-transplant mortality is needed in order to optimize the potential gains in overall survival obtained through improved long-term management of transplant recipients. There are limited data on the predictive ability of MELD score for early post-transplant mortality, and no data assessing the interaction between MELD score and hospitalization status. We analyzed UNOS data from 2002–2013 on 50,838 non-Status 1 single-organ liver transplant recipients and fit multivariable logistic models to evaluate the association and interaction between MELD score and pre-transplant hospitalization status on short-term post-transplant mortality. There was a significant interaction (p<0.01) between laboratory MELD score and hospitalization status on 3-, 6-, and 12-month post-transplant mortality in multivariable logistic models. This interaction was most pronounced in patients with a laboratory MELD score <25 transplanted from an ICU, whose adjusted predicted 3-, 6-, and 12-month post-transplant mortality approximated those of patients with a MELD score ≥30. Compared to hospitalized patients with a MELD score of 30–34, those with a MELD score ≥35 in an ICU had significantly increased risk of 3-month (OR: 1.54, 95% CI: 1.21–1.97), 6-month (OR: 1.35, 95% CI: 1.09–1.67), and 12-month (OR: 1.25, 95% CI: 1.03–1.52) post-transplant mortality. Pre-transplant ICU status modifies the risk of early post-transplant mortality, independent of MELD score. This should be considered when determining candidacy for transplantation in order to optimize efficient use of a scarce resource.