Longitudinal assessment of mortality risk among candidates for liver transplantation
Longitudinal assessment of mortality risk among candidates for liver transplantation
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DOI：
10.1053/jlts.2003.50009
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发表时间：
2003-01-01
影响因子：
4.6
通讯作者：
Held, PJ
中科院分区：
文献类型：
--
作者：
Merion, RM;Wolfe, RA;Held, PJ
肝脏分配政策最近进行了修改，以使用慢性肝病患者的终末期肝病模型（MELD），根据等待名单死亡的风险对潜在的接受者进行分层。在这项研究中，对1995年1月至2001年3月期间被列入肝移植等待名单并随访长达74个月的760例慢性肝病成人患者进行了回顾性队列研究，以评估MELD预测等待名单候选人死亡率的能力，并评估MELD评分随时间变化的预后重要性。系列MELD评分预测等候名单死亡率显着优于基线MELD评分或医疗紧急状态。MELD评分40分的每一个单位与等候名单死亡风险增加22%相关（P <0.001），而医疗紧急状态不是一个重要的独立预测因素。对于任何给定的MELD评分，前30天内MELD评分变化的幅度和方向（DeltaMELD）是显著的独立死亡率预测因子。MELD评分在30天内增加大于5分的患者的等待死亡风险是MELD评分逐渐增加的患者的3倍（P <0.0001）。我们的结论是，肝移植等候名单上的死亡风险预测更准确地通过一系列MELD评分测定比医疗紧急状态或单一MELD测量。DeltaMELD评分随时间的变化反映了肝脏疾病的进展，并传达了重要的额外预后信息，这些信息应在国家肝脏分配政策的进一步发展中予以考虑。
Liver allocation policy recently was modified to use the Model for End-Stage Liver Disease (MELD) for patients with chronic liver disease to stratify potential recipients according to risk for waitlist death. In this study, a retrospective cohort of 760 adult patients with chronic liver disease placed on the liver transplant waitlist between January 1995 and March 2001 and followed up for up to 74 months was studied to assess the ability of the MELD to predict mortality among waitlisted candidates and evaluate the prognostic importance of changes in MELD score over time. Serial MELD scores predicted waitlist mortality significantly better than baseline MELD scores or medical urgency status. Each unit of the 40-point MELD score was associated with a 22% increased risk for waitlist death (P < .001), whereas medical urgency status was not a significant independent predictor. For any given MELD score, the magnitude and direction of change in MELD score during the previous 30 days (DeltaMELD) was a significant independent mortality predictor. Patients with MELD score increases greater than 5 points over 30 days had a threefold greater waitlist mortality risk than those for whom MELD scores increased more gradually (P < .0001). We conclude that mortality risk on the liver transplant waitlist is predicted more accurately by serial MELD score determinations than by medical urgency status or single MELD measurements. DeltaMELD score over time reflects progression of liver disease and conveys important additional prognostic information that should be considered in the further evolution of national liver allocation policy.