The decreasing predictive power of MELD in an era of changing etiology of liver disease
The decreasing predictive power of MELD in an era of changing etiology of liver disease
复制标题
DOI：
10.1111/ajt.15559
复制
发表时间：
2019-12-01
影响因子：
8.8
通讯作者：
Rana, Abbas
中科院分区：
文献类型：
--
作者：
Godfrey, Elizabeth L.;Malik, Tahir H.;Rana, Abbas
在 MELD 时代，肝移植领域发生了很大变化，包括改变分配、免疫抑制和肝衰竭病因，以及更好的支持疗法。我们的目的是评估 MELD 评分随时间变化的预测准确性。器官共享联合网络提供了 2002 年至 2016 年间 120 156 名接受肝移植的患者的去识别化数据。 MELD 评分预测 90 天死亡率的能力通过一致性 (C-) 统计进行评估，并与竞争风险分析相证实。 MELD 评分与 90 天死亡率的一致性从 2003 年的 0.80 下降到 2015 年的 0.70。虽然在此期间列名和移植时的实验室 MELD 分数有所上升，但候补死亡分数保持稳定在 35 左右。列名年龄从 50 岁增加到 54 岁。上市时 HCV 阳性率从 33% 下降至 17%。 MELD 和死亡率的一致性不随年龄而变化（>60 = 0.73，
The field of liver transplantation has shifted considerably in the MELD era, including changing allocation, immunosuppression, and liver failure etiologies, as well as better supportive therapies. Our aim was to evaluate the predictive accuracy of the MELD score over time. The United Network for Organ Sharing provided de-identified data on 120 156 patients listed for liver transplant from 2002-2016. The ability of the MELD score to predict 90-day mortality was evaluated by a concordance (C-) statistic and corroborated with competing risk analysis. The MELD score's concordance with 90-day mortality has downtrended from 0.80 in 2003 to 0.70 in 2015. While lab MELD scores at listing and transplant climbed in that interval, score at waitlist death remained steady near 35. Listing age increased from 50 to 54 years. HCV-positive status at listing dropped from 33 to 17%. The concordance of MELD and mortality does not differ with age (>60 = 0.73,