在预测肝硬化患者死亡率方面，MELD3.0 优于 MELDNa 和 MELD：在多种族人群中进行外部验证

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY JGH Open Pub Date : 2024-06-02 DOI:10.1002/jgh3.13098

Hong-Yi Lin, Pooi Ling Loi, Jeanette Ng, Liang Shen, Wei-Quan Teo, Amber Chung, Prema Raj, Jason Pik-Eu Chang

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引用次数: 0

摘要

背景和目的为预测肝硬化患者的生存期，终末期肝病模型（MELD）已更新为 MELDNa，最近又更新为 MELD3.0。我们验证了 MELD3.0 的预后性能，并与肝硬化住院患者中的 MELDNa 和 MELD 进行了比较。方法对新加坡中央医院（SGH）2018 年 1 月 1 日至 2018 年 12 月 31 日期间肝硬化住院患者的人口统计学、临床、生化和生存数据进行了回顾性研究。患者从2018年首次入院开始随访，直至死亡或2023年4月1日。计算了 MELD3.0、MELDNa 和 MELD 对预测 30 天、90 天和 365 天死亡率的判别效果的接收者操作特征曲线下面积（AUROC）。用 DeLong 检验比较了 AUROC。使用尤登指数确定了 30 天死亡率高风险患者的 MELD3.0 临界值。用 Kaplan-Meier 法估算 MELD3.0 评分高于和低于临界值的患者的生存曲线，并用对数秩分析进行比较。结果共纳入 862 名患者（中位年龄 71.0 岁[四分位数间距：64.0-79.0]，65.4% 为男性，75.8% 为中国人）。Child-Turcotte-Pugh分级A/B/C的患者比例分别为55.5%/35.5%/9.0%。MELD3.0/MELDNa/MELD 评分中位数分别为 12.2（IQR：8.7-18.3）/11.0（IQR：8.0-17.5）/10.3（IQR：7.8-15.0）。中位随访时间为 51.9 个月（IQR：8.5-59.6）。30/90/365天死亡率分别为5.7%/13.2%/26.9%。MELD3.0/MELDNa/MELD预测30天、90天和365天死亡率的AUROC分别为0.823/0.793/0.783、0.754/0.724/0.707、0.682/0.654/0.644（P <0.05）。预测 30 天死亡率的最佳临界值为 MELD3.0 > 19（灵敏度 = 67.4%，特异性 = 82.4%）。与 MELD3.0 ≤ 19 的患者相比，MELD3.0 > 19 患者的中位死亡时间更短（98.0 天 [IQR: 28.8-398.0] vs 390.0 天 [IQR: 134.3-927.5] ），30 天死亡率更高（68.8% vs 43.0%）（P < 0.001）。结论在预测肝硬化住院患者死亡率方面，MELD3.0 优于 MELDNa 和 MELD。MELD3.0 > 19 预测的 30 天死亡率更高。

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MELD3.0 is superior to MELDNa and MELD for prediction of mortality in patients with cirrhosis: An external validation in a multi-ethnic population

Background and Aim

The model for end-stage liver disease (MELD) was updated to MELDNa and recently to MELD3.0 to predict survival of cirrhotic patients. We validated the prognostic performance of MELD3.0 and compared with MELDNa and MELD amongst cirrhotic inpatients.

Methods

Demographical, clinical, biochemical, and survival data of cirrhotic inpatients in Singapore General Hospital (SGH) from 01 January 2018 to 31 December 2018, were studied retrospectively. Patients were followed up from first admission in 2018 until death or until 01 April 2023. Area under the receiver operating characteristic curves (AUROC) were computed for the discriminative effects of MELD3.0, MELDNa, and MELD to predict 30-, 90-, and 365-day mortalities. AUROC was compared with DeLong's test. The cutoff MELD3.0 score for patients at high risk of 30-day mortality was determined using Youden's Index. Survival curves of patients with MELD3.0 score above and below the cutoff were estimated with Kaplan–Meier method and compared with log-rank analysis.

Results

Totally 862 patients were included (median age 71.0 years [interquartile range, IQR: 64.0–79.0], 65.4% males, 75.8% Chinese). Proportion of patients with Child-Turcotte-Pugh classes A/B/C were 55.5%/35.5%/9.0%. Median MELD3.0/MELDNa/MELD scores were 12.2 (IQR: 8.7–18.3)/11.0 (IQR: 8.0–17.5)/10.3 (IQR: 7.8–15.0). Median time of follow-up was 51.9 months (IQR: 8.5–59.6). The proportion of 30-/90-/365-day mortalities was 5.7%/13.2%/26.9%. AUROC of MELD3.0/MELDNa/MELD in predicting 30-, 90-, and 365-day mortalities, respectively, were 0.823/0.793/0.783, 0.754/0.724/0.707, 0.682/0.654/0.644 (P < 0.05). Optimal cutoff to predict 30-day mortality was MELD3.0 > 19 (sensitivity = 67.4%, specificity = 82.4%). Patients with MELD3.0 > 19, compared with patients with MELD3.0 ≤ 19, had shorter median time to death (98.0 days [IQR: 28.8–398.0] vs 390.0 days [IQR: 134.3–927.5]), and higher proportion of 30-day mortality (68.8% vs 43.0%) (P < 0.001).