乳酸浓度和终末期肝病模型评分对肝移植术后早期死亡率预测准确性的比较

Comparison of lactate concentration and model for end-stage liver disease to predict early mortality after liver transplantation

目的比较乳酸浓度与终末期肝病模型(model for end-stage liver disease, MELD)预测肝移植术后早期死亡率的准确性,为临床提供一种简便及时的预测工具。方法回顾性分析2017年于本院接受同种异体肝移植手术的121例患者的临床资料,男92例,女29例,年龄25～78岁,ASAⅢ或Ⅳ级。按术后30 d内是否存活分为两组:生存组和死亡组。收集术前和术毕乳酸浓度,计算术前和术毕MELD评分。比较两组术前乳酸浓度、术毕乳酸浓度、术前MELD评分和术毕MELD评分。采用受试者工作特征(receiver operating characteristic, ROC)曲线比较术前和术毕乳酸浓度和MELD评分对肝移植患者术后早期(术后30 d)死亡率的预测准确性。结果术后30 d内存活109例(90.0%),死亡12例(10.0%)。死亡组术前MELD评分、术前乳酸浓度、术毕MELD评分和术毕乳酸浓度均明显高于生存组(P<0.05)。术前乳酸浓度的ROC曲线下面积(area under the curve, AUC)为0.78(95%CI 0.63～0.93),临界值为2.43 mmol/L;术前MELD评分的AUC为0.70(95%CI 0.53～0.87),临界值为24.50分,两者AUC差异无统计学意义。术毕乳酸浓度的AUC为0.85(95%CI 0.70～0.99),临界值为9.57 mmol/L;术毕MELD评分的AUC为0.74(95%CI 0.61～0.88),临界值为25.42分;术毕乳酸浓度的AUC明显高于术毕MELD评分(P<0.05)。结论乳酸浓度,尤其是术毕乳酸浓度对于肝移植术后早期死亡率的预测能力优于MELD评分。

Objective To compare the accuracy of lactate concentration and model for end-stage liver disease(MELD)to predict early mortality after liver transplantation,and to provide a convenient and timely predictive tool for clinical work.Methods A total of 121 patients who underwent Allograft liver transplantation in 2017 in our hospital,92 males and 29 females,aged 25-78 years old,ASA physical statusⅢorⅣ,were selected to the retrospective study.Patients were divided into survival group and non-survival group,according whether survived within 30 days after the surgery.The preoperative and postoperative lactate concentrations were gotten and the preoperative and postoperative MELD scores were calculated.The preoperative lactate concentrations,postoperative lactate concentrations,preoperative MELD scores and postoperative MELD scores were compared between survival group and non-survival group,respectively.The predictive accuracy about early mortality(30 days)of lactate concentration and MELD score were compared at preoperation and postoperation through receiver operating characteristic,respectively.Results There were 109 patients(90.0%)survived and 12 patients(10.0%)non-survived within 30 days after the surgery.Compared with survival group,the preoperative lactate concentrations,postoperative lactate concentrations,preoperative MELD scores and postoperative MELD scores in the non-survival group were significantly increased(P<0.05).According to the ROC analysis,the area under the curve(AUC)of ROC of preoperative lactate concentration was 0.78(95%CI 0.62-0.93)with a cutoff value of 2.43 mmol/L,the AUC of preoperative MELD score was 0.70(95%CI 0.53-0.87)with a cutoff value of 24.50 scores.There was not statistically significant between the AUC of preoperative MELD score and lactate concentration.The AUC of postoperative lactate concentration was 0.85(95%CI 0.70-0.99)with a cutoff value of 9.57 mmol/L,the AUC of postoperative MELD score was 0.74(95%CI 0.61-0.88)with a cutoff value of 25.42 scores.The AUC of postoperative lactate concentration was statistically higher than that of MELD score(P<005).Conclusion The predictive capability of lactate concentration,especially that of postoperative lactate concentrations,was better than the predictive capability of MELD score.