术后首次MELD评分及其衍生评分对肝衰竭患者肝移植术后早期生存率的预测价值

目的  探讨术后首次终末期肝病模型(MELD)评分及其衍生评分MELD联合血清钠(MELD-Na)评分、MELD联合血乳酸(MELD-Lac)评分对于肝衰竭患者肝移植术后早期生存率的预测能力。方法  回顾性分析135例肝衰竭肝移植受者的临床资料，根据术后28 d的生存情况分为早期生存组(110例)和早期死亡组(25例)，比较两组患者的临床资料，采用受试者工作特征(ROC)曲线确定MELD评分、MELD-Na评分与MELD-Lac评分对肝衰竭患者肝移植术后早期生存率预测的最佳截取值，以评价不同评分预测肝衰竭患者肝移植术后早期生存率的能力。结果  两组患者术后首次MELD评分、MELD-Na评分、MELD-Lac评分比较，差异均有统计学意义(均为P < 0.05)。术后首次MELD评分、MELD-Na评分、MELD-Lac评分预测肝衰竭患者肝移植术后早期生存率的AUC分别为0.653 [95%可信区间(CI) 0.515~0.792]、0.648(95% CI 0.514~0.781)、0.809 (95% CI 0.718~0.900)，最佳截取值分别为18.09、18.09、19.97，约登指数分别为0.398、0.380、0.525，灵敏度分别为0.680、0.680、0.840，特异度分别为0.720、0.700、0.690。MELD-Lac评分预测肝衰竭患者肝移植术后早期生存率的AUC大于MELD评分和MELD-Na评分，差异均有统计学意义(均为P < 0.05)。结论  术后首次MELD评分及MELD-Na评分对于肝衰竭患者肝移植术后早期生存率预测能力一般，而术后首次MELD-Lac评分是肝衰竭患者肝移植术后早期生存率更为可靠的预测指标。

Predictive value of the initial MELD score and its derivative scores for early survival rate after liver transplantation in patients with liver failure

Objective To explore the predictive values of the initial model for end-stage liver disease (MELD) score, MELD combined with serum sodium (MELD-Na) score and MELD combined with serum lactic acid (MELD-Lac) score for early survival rate after liver transplantation in patients with liver failure. Methods Clinical data of 135 recipients undergoing liver transplantation for liver failure were retrospectively analyzed. All patients were divided into the early survival group (n=110) and early death group (n=25) according to the survival at postoperative 28 d. Clinical data were compared between two groups. The optimal cut-off values of MELD, MELD-Na and MELD-Lac scores for predicting early survival rate after liver transplantation in patients with liver failure were determined by the receiver operating characteristic (ROC) curve. The predictive values of different scores for early survival rate after liver transplantation in patients with liver failure were evaluated. Results Significant differences were observed in the initial MELD, MELD-Na and MELD-Lac scores after liver transplantation between two groups (all P < 0.05). For the initial MELD, MELD-Na and MELD-Lac scores in predicting early survival rate after liver transplantation in patients with liver failure, the AUC were 0.653 [95% confidence interval (CI) 0.515-0.792], 0.648 (95%CI 0.514-0.781) and 0.809 (95%CI 0.718-0.900), the optimal cut-off values were 18.09, 18.09 and 19.97, Youden's indexes were 0.398, 0.380 and 0.525, the sensitivity was 0.680, 0.680 and 0.840, and the specificity was 0.720, 0.700 and 0.690, respectively. The AUC of MELD-Lac score was higher than those of MELD and MELD-Na scores, and the differences were statistically significant (both P < 0.05). Conclusions Compared with the initial MELD and MELD-Na scores after liver transplantation, the initial MELD-Lac score is a more reliable index for predicting early survival rate after liver transplantation in patients with liver failure.