Model for End-stage Liver Disease
Model for End-stage Liver Disease
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DOI：
10.1016/j.jceh.2012.11.002
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发表时间：
2013-03-01
影响因子：
3
通讯作者：
Kamath, Patrick S.
中科院分区：
文献类型：
--
作者：
Singal, Ashwani K.;Kamath, Patrick S.
终末期肝病模型（MELD）评分，最初是为了预测经颈静脉肝内门体分流术后的生存率而开发的，后来发现是终末期肝病患者死亡率的准确预测因子。自2002年以来，使用3个客观变量（血清胆红素、血清肌酐和机构标准化比值）的MELD评分已在全球范围内用于终末期肝病患者的入组和移植，允许病情较重的患者首先接受移植，而不考虑入组的等待时间。MELD评分也被证明是酒精性肝炎患者、静脉曲张出血、肝硬化感染后、肝硬化患者手术（包括肝切除术、创伤和肝肾综合征（HRS））后生存率的准确预测因子。尽管MELD评分最接近理想评分，但仍存在一些局限性，包括其在15-20%病例中预测生存的不准确性。在过去的十年中，已经做出了许多努力，以进一步改善和完善MELD评分。在开发出更好的评分之前，将继续根据当前使用的MELD评分进行肝脏分配。
Model for end-stage liver disease (MELD) score, initially developed to predict survival following transjugular intrahepatic portosystemic shunt was subsequently found to be accurate predictor of mortality amongst patents with end-stage liver disease. Since 2002, MELD score using 3 objective variables (serum bilirubin, serum creatinine, and institutional normalized ratio) has been used worldwide for listing and transplanting patients with end-stage liver disease allowing transplanting sicker patients first irrespective of the wait time on the list. MELD score has also been shown to be accurate predictor of survival amongst patients with alcoholic hepatitis, following variceal hemorrhage, infections in cirrhosis, after surgery in patients with cirrhosis including liver resection, trauma, and hepatorenal syndrome (HRS). Although, MELD score is closest to the ideal score, there are some limitations including its inaccuracy in predicting survival in 15-20% cases. Over the last decade, many efforts have been made to further improve and refine MELD score. Until, a better score is developed, liver allocation would continue based on the currently used MELD score.