简化MELD评分可准确区分乙型肝炎相关肝硬化急性失代偿患者为不同短期预后群体

Simplified MELD Score Accurately Classifies HBV-related Cirrhotic Patients with Acute Decompensation into Different Short-term Prognostic Groups

背景:对肝硬化急性失代偿(AD)患者而言,在入院初期准确进行预后判断具有重要临床意义。CLIF-C OF、MELD、MELD-Na评分为较好的短期预后预测模型,但评分方法复杂在一定程度上限制了它们的使用。目的:提出更简单、客观的简化MELD评分系统,以期准确预测乙型肝炎相关肝硬化AD患者的短期预后。方法:回顾性连续纳入2005年1月—2010年12月上海仁济医院住院乙型肝炎相关肝硬化AD患者共890例,收集患者临床数据和预后信息。计算入院当天简化MELD评分(含总胆红素、国际标准化比值、肌酐三项指标),根据评分及其对应的28 d死亡率进行预后分群。以Kaplan-Meier生存曲线比较各群体1年累积生存率,以ROC曲线分析各预后模型预测28 d死亡的预测效能。结果:根据入院当天简化MELD评分可将乙型肝炎相关肝硬化AD患者分为低、中、高28 d死亡率和不同中长期预后群体,三组对应评分分别为0~2分、3分和4~6分,28 d死亡率分别为5.5%、19.8%和48.6%。简化MELD评分预测28 d死亡的预测效能与CLIF-C OF、MELD、MELD-Na评分无明显差异,ROC曲线下面积分别为0.828、0.831、0.828和0.830。结论:简化MELD评分可准确地在入院当天将乙型肝炎相关肝硬化AD患者区分为低、中、高28 d死亡率群体,评分方法简单,便于临床应用。

Background: For patients with liver cirrhosis and acute decompensation( AD),it is of great clinical importance to predict short-term mortality at admission. It has been reported that CLIF-C OF,MELD and MELD-Na score can accurately predict the short-term mortality,but all these scoring systems are complicated and have limits in their application. Aims:To define a simple and objective scoring system-- simplified MELD score for short-term mortality prediction in HBV-related cirrhotic patients with AD. Methods: A total of 890 consecutive HBV-related cirrhotic patients with AD hospitalized during Jan. 2005 to Dec. 2010 at Shanghai Ren Ji Hospital were enrolled retrospectively. Clinical data and patients’ outcome were collected,and simplified MELD score was calculated by using total bilirubin,international normalized ratio and creatinine values at admission. Patients were classified into different prognostic groups according to their 28-day mortalities and simplified MELD score. Kaplan-Meier survival curve was used to analyze the 1-year accumulate survival rate,and ROC curve was used to evaluate the performance of different scoring systems in predicting 28-day mortality. Results: Simplified MELD score at admission could classify HBV-related cirrhotic patients with AD into low,moderate and high 28-day mortality groups and different long-term prognostic groups; the score of low,moderate and high 28-day mortality group was0-2,3 and 4-6,respectively,and the corresponding mortality was 5. 5%,19. 8% and 48. 6%,respectively. Simplified MELD score had the same good performance as compared with the CLIF-C OF,MELD and MELD-Na scores in predicting 28-day mortality,the area under ROC curve was 0. 828,0. 831,0. 828 and 0. 830,respectively. Conclusions: Simplified MELD score can accurately classify HBV-related cirrhotic patients with AD into low,moderate and high 28-day mortality groups at admission. It is convenient for using in clinical practice.