A model to predict survival in patients with end-stage liver disease
A model to predict survival in patients with end-stage liver disease
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DOI：
10.1053/jhep.2001.22172
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发表时间：
2001-02-01
期刊：
影响因子：
13.5
通讯作者：
Kim, WR
中科院分区：
文献类型：
--
作者：
Kamath, PS;Wiesner, RH;Kim, WR
最近的一项指令强调肝脏疾病的严重程度，以确定肝移植器官分配的优先顺序，并需要基于可概括、可验证和易于获得的变量的疾病严重程度指数。该研究的目的是检验先前创建的模型的普遍性，该模型用于估计接受经颈静脉肝内门体分流术 (TIPS) 手术的患者在疾病严重程度和病因范围更广的患者群体中的生存率。终末期肝病 (MELD) 模型由血清胆红素和肌酐水平、凝血酶原时间国际标准化比值 (INR) 以及肝病病因组成。该模型的有效性在4个独立数据集中进行了测试，包括（1）因肝功能失代偿而住院的患者（称为“住院”患者），（2）非胆汁淤积性肝硬化门诊患者，（3）原发性胆汁性肝硬化（PBC）患者，以及（4）未经选择的20世纪80年代肝硬化患者（称为“历史”患者）。在这些患者中，使用一致性 (c) 统计量检查模型根据死亡风险对患者进行分类的能力。MELD 量表在预测 3 个月内死亡方面表现良好，c 统计量为 (1) 住院患者为 0.87，(2) 非胆汁淤积性门诊患者为 0.80，(3) PBC 患者为 0.87，(4) 既往肝硬化患者为 0.78。门静脉高压症的个体并发症对模型预测的影响极小（c 统计量的改善范围：
A recent mandate emphasizes severity of liver disease to determine priorities in allocating organs for liver transplantation and necessitates a disease severity index based on generalizable, verifiable, and easily obtained variables. The aim of the study was to examine the generalizability of a model previously created to estimate survival of patients undergoing the transjugular intrahepatic portosystemic shunt (TIPS) procedure in patient groups with a broader range of disease severity and etiology. The Model for End-Stage Liver Disease (MELD) consists of serum bilirubin and creatinine levels, International Normalized Ratio (INR) for prothrombin time, and etiology of liver disease. The model's validity was tested in 4 independent data sets, including (1) patients hospitalized for hepatic decompensation (referred to as "hospitalized" patients), (2) ambulatory patients with noncholestatic cirrhosis, (3) patients with primary biliary cirrhosis (PBC), and (4) unselected patients from the 1980s with cirrhosis (referred to as "historical" patients). In these patients, the model's ability to classify patients according to their risk of death was examined using the concordance (c)-statistic, The MELD scale performed well in predicting death within 3 months with a c-statistic of (1) 0.87 for hospitalized patients, (2) 0.80 for noncholestatic ambulatory patients, (3) 0.87 for PBC patients, and (4) 0.78 for historical cirrhotic patients. Individual complications of portal hypertension had minimal impact on the model's prediction (range of improvement in c-statistic: