摘要
Background: The Model for End-Stage Liver Disease (MELD) score is an important and well established tool for assessing prognosis in patients with liver cirrhosis. It has been suggested that the longitudinal evaluation of the MELD score may reflect the progression of liver failure more reliably and therefore be more useful in prognostic assessment. Aim: To assess the prognostic meaning of MELD score modifications in a cohort of cirrhotic patients in whom clinical and bioche mical workup was carried out at least twice during a minimum interval of 30 days . Methods: Forty-six cirrhotic patients were longitudinally evaluated for a med ian follow-up of 365 days. After initial assessment, all the patients had at le ast one clinical and biochemical reevaluation during follow-up, which was perfo rmed no less than 1 month after initial evaluation. MELD was calculated at entry and at second evaluation. △MELD was calculated as MELD at second evaluation mi nus MELD at entry. △MELD/time was calculated as △MELD divided by time elapsed between initial assessment and second evaluation expressed in months. Results: D uring follow-up, 13 patients died (28%). The median interval between clinical evaluations was 120 days. MELD scores at entry (13 ±4 vs 16 ±6, P = 0.0516) an d △MELD (0 ±4 vs 4 ±2, P = 0.0028) were significantly different between patie nts who died and those who survived during the 1-year follow-up. All the patie nts who died during follow-up showed an increase of at least 1 unit in △MELD/t ime (sensitivity = 100%), and all the patients who survived showed a decrease o f more than 1 unit in △MELD/time (specificity = 100%). Conclusions: Longitudin al evaluation of the MELD score provides important prognostic information that s eems to complete the prognostic definition provided by “static" MELD. Prospecti ve studies in larger series are needed to validate the prognostic use of MELD mo difications over time.
Background: The Model for End-Stage Liver Disease (MELD) score is an important and well established tool for assessing prognosis in patients with liver cirrhosis. It has been suggested that the longitudinal evaluation of the MELD score may reflect the progression of liver failure more reliably and therefore be more useful in prognostic assessment. Aim: To assess the prognostic meaning of MELD score modifications in a cohort of cirrhotic patients in whom clinical and bioche mical workup was carried out at least twice during a minimum interval of 30 days . Methods: Forty-six cirrhotic patients were longitudinally evaluated for a med ian follow-up of 365 days. After initial assessment, all the patients had at le ast one clinical and biochemical reevaluation during follow-up, which was perfo rmed no less than 1 month after initial evaluation. MELD was calculated at entry and at second evaluation. △MELD was calculated as MELD at second evaluation mi nus MELD at entry. △MELD/time was calculated as △MELD divided by time elapsed between initial assessment and second evaluation expressed in months. Results: D uring follow-up, 13 patients died (28%). The median interval between clinical evaluations was 120 days. MELD scores at entry (13 ±4 vs 16 ±6, P = 0.0516) an d △MELD (0 ±4 vs 4 ±2, P = 0.0028) were significantly different between patie nts who died and those who survived during the 1-year follow-up. All the patie nts who died during follow-up showed an increase of at least 1 unit in △MELD/t ime (sensitivity = 100%), and all the patients who survived showed a decrease o f more than 1 unit in △MELD/time (specificity = 100%). Conclusions: Longitudin al evaluation of the MELD score provides important prognostic information that s eems to complete the prognostic definition provided by “static' MELD. Prospecti ve studies in larger series are needed to validate the prognostic use of MELD mo difications over time.
