MELD相关评分系统对肝衰竭患者生存情况的评估价值

目的比较MELD、MELD-Na、I-MELD评分系统对肝衰竭患者短期(90 d)生存预后的判定价值。方法回顾分析33例肝衰竭患者的资料,计算确诊时MELD、MELD-Na、I-MELD评分,将患者分为生存组和死亡组,用受试者工作曲线(ROC)曲线下面积比较3种方法对结局的预测能力,获取MELD、MELD-Na、I-MELD判断预后的最佳界值点,根据最佳界值点分组,比较组间的病死率。结果生存组患者MELD、MELD-Na、I-MELD评分分别是(26.16±8.76)分、(27.26±8.81)分和(37.17±8.76)分;死亡组分别是(28.49±12.53)分、(30.67±13.00)分和(50.92±13.28)分。3种方法的曲线下面积分别是0.595<0.609<0.768;95%的可信区间分别是0.384～0.807、0.381～0.838和0.579～0.957。3种评分系统最好的界值点分别是21.41、21.74和42.56。同MELD和MELD-Na评分系统相比较,I-MELD评分同前者差异有统计学意义(P<0.05)。结论 I-MELD评分相对于MELD、MELD-Na评分系统,能更好地预测肝衰竭患者的短期生存情况。

Evaluation on prognosis of survival situation of liver failure patients by using MELD score system

Objective To evaluate the prognostic MELD,MELD-Na and I-MELD score systems' value in predicting survival situation for liver failure patients.Methods Clinical data of 33 patients with liver failure were collected.The MELD score,MELD-Na score and I-MELD score were calculated on the first day of admission.The final outcome in 90th days post admission was used as the endpoint in this study.The predictive prognosis was compared using receiver operating curve(ROC) by the area under the curve(AUC) of three parameters.Cutoff values of MELD,MELD-Na and I-MELD score were calculated to determine the prognostic death risk.Mortality rates of different groups which were divided according to three cutoffs were assessed.Results MELD,MELD-Na,I-MELD score of survival group were(26.16±8.76,27),(26±8.81),and(37.17±8.76) respectively,and those for the death group were(28.49±12.53),(30.67±13.00),and(50.92±13.28) respectively.The AUC generated by the ROC was 0.595(95% CI 0.384-0.807) for MELD,0.609(95% CI 0.381-0.838) for MELD-Na,and 0.768(95% CI 0.579-0.957) for I-MELD.Patients with I-MELD score had a higher mortality(P<0.05).Conclusion Compared with MELD and MELD-Na score systems,I-MELD score is a better prognostic model for predicting the survival situation for liver failure patients.