Model of end stage liver disease (MELD) score greater than 23 predicts length of stay in the ICU but not mortality in liver transplant recipients.
Model of end stage liver disease (MELD) score greater than 23 predicts length of stay in the ICU but not mortality in liver transplant recipients.
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DOI：
10.1186/cc9068
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Béchir M
中科院分区：
文献类型：
--
作者：
Oberkofler CE;Dutkowski P;Stocker R;Schuepbach RA;Stover JF;Clavien PA;Béchir M
终末期肝病模型（MELD）评分对术后发病率和死亡率的影响仍然是难以捉摸的，特别是对于高MELD。有报告称，MELD评分高的移植候选者的患者预后较差，但其他人报告称MELD评分对预后和生存率没有影响。我们回顾性分析了从2003年1月至2008年12月在我们的移植单位连续72个月的144例肝移植受者的数据，并对发病率和死亡率进行了单因素和多因素分析，特别是确定MELD对这些参数的影响。这项研究确定MELD评分大于23是重症监护室（ICU）住院时间超过10天（比值比7.0）的发病率的独立风险因素，但与此相反，对死亡率没有负面影响。此外，我们确定输注超过7个单位的红细胞是死亡率（风险比7.6）和延长ICU住院时间（比值比[OR] 7.8）的独立风险因素，同时输注超过10个单位的新鲜冷冻血浆（OR 11.6）。术后肾功能衰竭是发病率的强预测因子（OR 7.9），术后肾脏替代治疗与死亡率增加高度相关（风险比6.8），移植前肝肾综合征也是如此（风险比13.2）。该研究确定MELD评分大于23是ICU停留时间超过10天的发病率的独立风险因素，但与此相反，对死亡率没有负面影响。这一发现支持MELD评分高但仅知道发病率增加的患者的移植。
The impact of model of end stage liver disease (MELD) score on postoperative morbidity and mortality is still elusive, especially for high MELD. There are reports of poorer patient outcome in transplant candidates with high MELD score, others though report no influence of MELD score on outcome and survival. We retrospectively analyzed data of 144 consecutive liver transplant recipients over a 72-month period in our transplant unit, from January 2003 until December 2008 and performed uni- and multivariate analysis for morbidity and mortality, in particular to define the influence of MELD to these parameters. This study identified MELD score greater than 23 as an independent risk factor of morbidity represented by intensive care unit (ICU) stay longer than 10 days (odds ratio 7.0) but in contrast had no negative impact on mortality. Furthermore, we identified transfusion of more than 7 units of red blood cells as independent risk factor for mortality (hazard ratio 7.6) and for prolonged ICU stay (odds ratio [OR] 7.8) together with transfusion of more than 10 units of fresh frozen plasma (OR 11.6). Postoperative renal failure is a strong predictor of morbidity (OR 7.9) and postoperative renal replacement therapy was highly associated with increased mortality (hazard ratio 6.8), as was hepato renal syndrome prior to transplantation (hazard ratio 13.2). This study identified MELD score greater than 23 as an independent risk factor of morbidity represented by ICU stay longer than 10 days but in contrast had no negative impact on mortality. This finding supports the transplantation of patients with high MELD score but only with knowledge of increased morbidity.
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影响因子：
19.6
作者：
Cabezuelo, JB;Ramírez, P;Parrilla, P
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