Hyponatremia and mortality among patients on the liver-transplant waiting list.
Hyponatremia and mortality among patients on the liver-transplant waiting list.
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DOI：
10.1056/nejmoa0801209
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发表时间：
2008-09-04
期刊：
影响因子：
--
通讯作者：
Therneau TM
中科院分区：
文献类型：
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作者：
Kim WR;Biggins SW;Kremers WK;Wiesner RH;Kamath PS;Benson JT;Edwards E;Therneau TM
在目前的肝移植政策下，捐赠器官被提供给死亡风险最高的患者。利用2005年和2006年在器官采购和移植网络注册的所有初次肝移植成年候选人的数据，我们开发并验证了一个多变量生存模型，以预测注册后90天的死亡率。预测变量为终末期肝病模型评分(MELD)，有无增加血钠浓度。MELD评分(从6到40，数值越高，表明疾病越严重)是根据血清胆红素和肌酐浓度以及凝血酶原时间的国际标准化比率来计算的。2005年，共有6769名登记者，其中1781人接受了肝脏移植，422人在登记后90天内在等待名单上死亡。MELD评分和血钠浓度均与死亡率显著相关(死亡风险比为1.21mmol/L，血钠浓度每升下降1.05mmol值；P<；0.001)。此外，MELD评分与血钠浓度之间存在显著的交互作用，表明血钠浓度的影响在MELD评分较低的患者中更大。当应用于2006年的数据时，当477名患者在等待名单上登记后3个月内死亡时，在32名死亡患者(7%)中，MELD评分和血钠浓度的组合显著高于单独使用MELD评分。因此，根据MELD评分结合血钠浓度分配优先顺序可能会导致移植和预防死亡。这项全人群研究表明，MELD评分和血钠浓度是预测肝移植患者存活的重要指标。
Under the current liver-transplantation policy, donor organs are offered to patients with the highest risk of death. Using data derived from all adult candidates for primary liver transplantation who were registered with the Organ Procurement and Transplantation Network in 2005 and 2006, we developed and validated a multivariable survival model to predict mortality at 90 days after registration. The predictor variable was the Model for End-Stage Liver Disease (MELD) score with and without the addition of the serum sodium concentration. The MELD score (on a scale of 6 to 40, with higher values indicating more severe disease) is calculated on the basis of the serum bilirubin and creatinine concentrations and the international normalized ratio for the prothrombin time. In 2005, there were 6769 registrants, including 1781 who underwent liver transplantation and 422 who died within 90 days after registration on the waiting list. Both the MELD score and the serum sodium concentration were significantly associated with mortality (hazard ratio for death, 1.21 per MELD point and 1.05 per 1-unit decrease in the serum sodium concentration for values between 125 and 140 mmol per liter; P<0.001 for both variables). Furthermore, a significant interaction was found between the MELD score and the serum sodium concentration, indicating that the effect of the serum sodium concentration was greater in patients with a low MELD score. When applied to the data from 2006, when 477 patients died within 3 months after registration on the waiting list, the combination of the MELD score and the serum sodium concentration was considerably higher than the MELD score alone in 32 patients who died (7%). Thus, assignment of priority according to the MELD score combined with the serum sodium concentration might have resulted in transplantation and prevented death. This population-wide study shows that the MELD score and the serum sodium concentration are important predictors of survival among candidates for liver transplantation.