Comparison of MELD, Child-Pugh, and emory model for the prediction of survival in patients undergoing transjugular intrahepatic portosystemic shunting
Comparison of MELD, Child-Pugh, and emory model for the prediction of survival in patients undergoing transjugular intrahepatic portosystemic shunting
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DOI：
10.1016/s0002-9270(03)00295-8
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发表时间：
2003-05-01
影响因子：
9.8
通讯作者：
Sauerbruch, T
中科院分区：
文献类型：
--
作者：
Schepke, M;Roth, F;Sauerbruch, T
目的：最近，提出了新的预后模型（终末期肝病模型[MELD模型]和Emory评分）用于预测经颈静脉肝内门体分流术（TIPS）患者的生存率。虽然MELD模型被认为是上级的，并已连续应用于肝移植的优先列表，这些模型从来没有直接比较的长期预后。因此，我们在一个长期随访的TIPS患者队列中比较了不同模型的预后准确性，包括Child-Pugh评分。162例连续TIPS患者的基线风险评分，随访至死亡（n = 81）、肝移植或观察结束（n = 81）（平均随访30.7 +/- 26.4个月）进行计算，并对三种模型的3个月、12个月和36个月生存率的预测准确性进行统计学比较。MELD模型生成了12个月（c-统计量0.73，95% CI = 0.64-0.82）和36个月生存期（c-统计量0.74，95% CI = 0.64-0.84）的最佳c-统计量。Emory评分的预测准确性显著较低（12个月生存期的c-统计量：0.60，95% CI = 0.52-0.68，p = 0.012 vs MELD）。在MELD和Child-Pugh模型的统计学比较中，仅观察到MELD预测肠出血患者1年生存率的趋势（MELD：c-统计量0.78，95% CI = 0.67-0.89; Child-Pugh：c-统计量0.67，95% CI = 0.55-0.80，p = 0.059）。MELD模型在预测TIPS患者长期生存率方面上级于Emory评分，但仅略上级于Child-Pugh分级。(C)2003年，我胃肠病学。
OBJECTIVES: Recently, new prognostic models (Model for End-Stage Liver Disease [MELD model] and Emory score) were proposed for the prediction of survival in transjugular intrahepatic portosystemic shunt (TIPS) patients. Although the MELD model is considered to be superior and has consecutively been applied to priority listing for liver transplantation, these models have never been directly compared in terms of long-term prognosis. We therefore compared the prognostic accuracy of the different models, including the Child-Pugh score, in an unselected cohort of TIPS patients followed long-term.METHODS: Baseline risk scores for 162 unselected consecutive TIPS patients followed until death (n = 81), liver transplantation, or end of observation (n = 81) (mean follow-up 30.7 +/- 26.4 months) were calculated, and respective concordance-(c-)statistics for the predictive accuracy of 3-, 12-, and 36-month survival for the three models were compared statistically.RESULTS: All three models predicted short-term (3-month) survival with similar accuracy. The MELD model generated the best c-statistics for both 12-month (c-statistic 0.73, 95% Cl = 0.64-0.82) and 36-month survival (c-statistic 0.74, 95% Cl = 0.64-0.84). The predictive accuracy of the Emory score was significantly lower (c-statistic for 12-month survival: 0.60, 95% CI = 0.52-0.68, p = 0.012 vs MELD). In the statistical comparison of the MELD and the Child-Pugh model, only a trend favoring MELD for the prediction of 1-yr survival in patients with intestinal bleeding could be observed (MELD: c-statistic 0.78, 95% Cl = 0.67-0.89; Child-Pugh: c-statistic 0.67, 95% CI = 0.55-0.80, p = 0.059).CONCLUSIONS: The MELD model is superior to the Emory score but only slightly superior to the Child-Pugh classification for the prediction of long-term survival in TIPS patients. (C) 2003 by Am. Coll. of Gastroenterology.