From Child-Pugh to MELD score and beyond: Taking a walk down memory lane
From Child-Pugh to MELD score and beyond: Taking a walk down memory lane
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DOI：
10.1016/j.aohep.2021.100535
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发表时间：
2021-10-15
影响因子：
3.8
通讯作者：
Freeman, Richard B.
中科院分区：
文献类型：
--
作者：
Ruf, Andres;Dirchwolf, Melisa;Freeman, Richard B.
Child-Turcotte-Pugh(CTP)和MELD(终末期肝病模型)评分用于预测门脉高压症减压治疗的结果。它们被前瞻性地验证为预测具有广泛肝病病因和严重程度的患者的死亡风险。与CTP评分不同，MELD评分是从前瞻性收集的数据中得出的。其计算依据是血清胆红素、血肌酐、国际标准化比率(INR)和肝病的病因。建立一个不强调等待时间的连续疾病严重程度评分，可以更好地对等待的患者进行分类，并提高透明度。美国在2002年建立了MELD系统，此后不久，包括拉丁美洲在内的世界各地都采用了基于MELD的肝脏分配。基于MELD的政策最显著的影响是降低了等待名单上的死亡率。在MELD系统实施后的几年里，人们提出了几种方案来提高MELD评分的准确性。加入血清钠(MELD-Na)增加了评分在预测等待名单死亡率方面的准确性，从而完善了最初的MELD评分作为肝脏分配的预后模型。在MELD评分创建20周年之际，我们简要介绍了它的发展，它用于对等待肝移植的患者进行分层，以及它作为肝脏分配系统的采用。(C)2021年南方医学基金会。埃尔塞维尔·埃斯帕纳出版，S.L.U。这是CC By-NC-ND许可证(http://creativecommons.org/licenses/by-nc-nd/4.0/)下的一篇开放获取文章
The Child-Turcotte-Pugh (CTP) and the MELD (Model for End-Stage Liver Disease) scores were designed to predict the outcome of decompressive therapy for portal hypertension. They were prospectively validated to predict mortality risk in patients with a wide spectrum of liver disease etiology and severity. Unlike the CTP score, the MELD score was derived from prospectively gathered data. Its calculation was based on serum bilirubin, serum creatinine, international normalized ratio (INR) and etiology of liver disease. Instituting a continuous disease severity score that de-emphasizes waiting time resulted in better categorization of waiting patients and enhanced transparency. The US instituted the MELD system in 2002 and soon thereafter, MELDbased liver allocation was adopted throughout the world including Latin America. The most significant impact of MELD-based policies has been the reduction of waiting-list mortality. In the years after implementation of the MELD system, several options have been proposed to improve the MELD score's accuracy. Adding serum sodium (MELD-Na) increased the accuracy of the score in predicting waiting list mortality, thus completing the original MELD score as a prognostic model in liver allocation. On the 20th anniversary of the creation of MELD score we present a brief account of its development, its use to stratify patients on the waiting list for liver transplantation as well as its adoption as liver allocation system . (c) 2021 Fundacion Clinica Medica Sur, A.C. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)