MELD score versus conventional UNOS status in predicting short‐term mortality after liver transplantation *
MELD score versus conventional UNOS status in predicting short‐term mortality after liver transplantation *
复制标题
MELD 评分与传统 UNOS 状态在预测肝移植后短期死亡率方面的比较 *
作者：
G. Santori;E. Andorno;N. Morelli;A. Antonucci;G. Bottino;R. Mondello;A. Castiglione;R. Valente;F. Ravazzoni;S. D. Domenico;U. Valente
终末期肝病模型 (MELD) 提供了一个能够预测等待肝移植 (LT) 患者短期死亡率的评分。 2002年初，器官共享联合网络（UNOS）提出用修改后的MELD评分取代传统的3、2B和2A状态。然而，MELD 模型预测移植后结果的准确性相当难以捉摸。在本研究中，我们研究了 MELD 评分与传统 UNOS 状态相比对短期患者和移植物死亡率的预测价值。根据严格标准，纳入了 UNOS 状态 3 (n = 5)、2B (n = 55) 或 2A (n = 9) 状态的 69 名接受 LT 的患者。没有与供体相关的参数影响患者 3 个月的生存率。通过单变量 Cox 回归，移植前国际标准化比值 (P = 0.049) 和活化部分凝血活酶时间 (P = 0.032) 与 3 个月患者生存率显着相关，尽管在随后的多变量分析中并未发现。 MELD 总体得分为 17 ± 6.63（中位数：16，范围：4-34），从 UNOS 状态 3 增加到 2A（r2 = 0.171，P = 0.0001）。接受第二次 LT 的患者与未接受第二次 LT 的患者的中位 MELD 评分没有显着差异（P =0.458）。临床紧急程度分类后，UNOS 状态和 MELD 评分之间的速率间一致性显示出相当的一致性 (κ = 0.244)。 3个月患者死亡率和移植物死亡率分别为15.94%和20.29%。尽管 MELD 评分显示出对短期患者死亡率的主要敏感性（0.637；95%CI：0.513-0.75），但一致性统计并未发现 3 个月患者的 UNOS 状态与 MELD 评分（P = 0.283）或移植物死亡率（P = 0.957）之间存在显着性。这些发现表明需要实施 MELD 模型的准确性，以实现与 UNOS 状态和患者结果的速率间一致性。
The Model for End‐stage Liver Disease (MELD) provides a score able to predict short‐term mortality in patients awaiting liver transplantation (LT). In the early 2002, United Network for Organ Sharing (UNOS) has proposed to replace the conventional statuses 3, 2B, and 2A with a modified MELD score. However, the accuracy of the MELD model to predict post‐transplantation outcome is fairly elusive. In the present study we investigated the predictive value of the MELD score for short‐term patient and graft mortality in comparison with conventional UNOS status. Sixty‐nine patients listed at UNOS status 3 (n = 5), 2B (n = 55) or 2A (n = 9) who underwent LT were enrolled according to strict criteria. No donor‐related parameters affected 3‐month patient survival. Through univariate Cox regression, pretransplantation international normalized ratio (P = 0.049) and activated partial thromboplastin time (P = 0.032) were significantly associated with 3‐month patient survival, although not in the subsequent multivariate analysis. The overall MELD score was 17 ± 6.63 (median: 16, range: 4–34), increasing from UNOS Status 3 to 2A (r2 = 0.171, P = 0.0001). No significant difference occurred in the median MELD score between patients who underwent a second LT and those who did not (P =0.458). The inter‐rate agreement between UNOS status and MELD score after categorization for clinical urgency showed a fair agreement (κ = 0.244). The 3‐month patient and graft mortality was 15.94% and 20.29% respectively. The concordance statistic did not find significance between UNOS status and MELD score for 3‐month patient (P = 0.283) or graft mortality (P = 0.957), although the MELD score revealed a major sensitivity for short‐term patient mortality (0.637; 95%CI: 0.513–0.75). These findings suggest the need to implement MELD model accuracy for both inter‐rate agreement with UNOS Status and patient outcome.
影响因子：
9
作者：
TZAKIS, A;TODO, S;STARZL, TE
通讯作者：
STARZL, TE