MELD和SOFA评分系统对预测慢加急性肝衰竭患者短期预后的临床应用价值

肝脏 ›› 2016, Vol. 21 ›› Issue (8): 620-622.

MELD和SOFA评分系统对预测慢加急性肝衰竭患者短期预后的临床应用价值

谢莹, 吴志勤, 杭小锋, 张瑞祺, 徐文胜

200003 上海第二军医大学长征医院感染科

收稿日期:2016-05-31 出版日期:2016-08-31 发布日期:2020-07-09
通讯作者: 吴志勤,Email:wzqlzw@126.com

The clinical value of MELD and SOFA scoring system in predicting short-term prognosis to acute-on-chronic liver failure patients

XIE Ying, WU Zhi-qin, HANG Xiao-feng, ZHANG Rui-qi, XU Wen-sheng

Department of Infectious Diseases, ChangZheng Hospital, Second Military Medical University, ShangHai 200003, China

Received:2016-05-31 Online:2016-08-31 Published:2020-07-09
Contact: WU Zhi-qin,Email: wzqlzw@126.com

摘要/Abstract

摘要： 目的评价终末期肝病模型(MELD) 和序贯器官衰竭估计(SOFA)评分系统对预测慢加急性肝衰竭(ACLF)患者短期预后的临床应用价值。方法对78例慢加急性肝衰竭患者的资料进行回顾性分析,依据治疗3个月时患者的生存情况分为死亡组和生存组,分别进行MELD和SOFA系统评分。应用受试者工作特征曲线(ROC)评价预测价值,并用K-M生存曲线分析两种预测模型的差异。结果 MELD和SOFA分值均能够较好地预测慢加急性肝衰竭患者3个月内的病死率,C-statistic 分别为0.826和0.825,两者的预测能力比较差异无统计学意义(Z=0.0148,P=0.988)。SOFA评分<7分和MELD评分<23.9分患者分别较SOFA评分≥7分和MELD评分≥23.9分者生存率显著增高,差异有统计学意义(χ²值分别为17.66 和 28.33,P值均为0.000)。结论 MELD和SOFA评分系统在预测慢加急性肝衰竭患者短期预后方面效果相近。

关键词: 终末期肝病模型, 序贯器官衰竭, 慢加急性肝衰竭, 预后

Abstract: Objective To investigate the clinical value of the model for end-stage liver disease (MELD) and the sequential organ failure assessment (SOFA) scoring systems in predicting short-term prognosis of patients with acute-on-chronic liver failure (ACLF).Methods Seven-eight ACLF patients were divided into survival group and death group according to their 3-month living conditions. MELD and SOFA score were calculated among those patients. Receiver operating characteristic curve (ROC) was applied to evaluate the predictive value, and differences between two models were analyzed by K-M survival curve.Results MELD and SOFA scoring systems could well predict the mortality of ACLF patients in 3 months with C-statistics of 0.826 and 0.825, respectively, which showed no significant differences (Z=0.0148, P=0.988). Compared with patients with SOFA score ≥ 7 points and MELD score ≥ 23.9 points, patients with SOFA score < 7 points and MELD score < 23.9 points had significantly higher survival rate, respectively (χ²=17.66 and 28.33, both P=0.000).Conclusion Efficiencies of MELD and SOFA scoring systems shows no significant difference in predicting the short-term prognosis of ACLF patients.

Key words: MELD, SOFA, Acute-on-chronic liver failure, Prognosis

谢莹, 吴志勤, 杭小锋, 张瑞祺, 徐文胜. MELD和SOFA评分系统对预测慢加急性肝衰竭患者短期预后的临床应用价值[J]. 肝脏, 2016, 21(8): 620-622.

XIE Ying, WU Zhi-qin, HANG Xiao-feng, ZHANG Rui-qi, XU Wen-sheng. The clinical value of MELD and SOFA scoring system in predicting short-term prognosis to acute-on-chronic liver failure patients[J]. Chinese Hepatolgy, 2016, 21(8): 620-622.

参考文献

[1] Zamora Nava LE, Aguirre Valadez J, Chávez-Tapia NC, et al. Acute-on-chronic liver failure: a review. Ther Clin Risk Manag, 2014, 10: 295-303.
[2] 中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病分会重型肝病与人工肝学组. 肝衰竭诊治指南(2012年版). 中华肝脏病杂志,2013,21:177-183.
[3] Bambha K, Kim WR, Kremers WK, et al. Predicting survival among patients listed for liver transplantation: an assessment of serial MELD measurements. Am J Transplant, 2004, 4 : 1798-1804.
[4] Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med, 1996, 22: 707-710.
[5] Namendys-Silva SA, Texcocano-Becerra J, Herrera-Gomez A. Application of the Sequential Organ Failure Assessment (SOFA) score to patients with cancer admitted to the intensive care unit. Am J Hosp Palliat Care, 2009, 26:341-346.
[6] Cholongitas E, Betrosian A, Senzolo M, et al. Prognostic models in cirrhotics admitted to intensive care units better predict outcome when assessed at 48 h after admission. J Gastroenterol Hepatol, 2008, 23:1223-1227.
[7] Sen S, Williams R, Jalan R. The pathophysiological basis of acute-on-chronic liver failure. Liver, 2002, 22 :5-13.
[8] Kamath PS, Wiesner RH, Malinehoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology, 2001, 33 :464-470.
[9] Fejfar T, Safka V, Hulek P, et al. MELD score in prediction of early mortality in patients suffering refractory ascites treated by TIPS. Vnitr Lek, 2006, 52 :771-776.
[10] Yu JW, Wang GQ, Li SC. Prediction of the prognosis in patients with acute-on-chronic hepatitis using the MELD scoring system. Gastroenterol Hepatol, 2006, 21 :1519-1524.
[11] Cholongitas E, Senzolo M, Patch D, et al. Risk Factors, SOFA and MELD scores for predicting short term mortality in cirrhotics admitted to intensive care unit. Alimentary Pharmacology Therapeutic, 2006, 23: 883-893.
[12] Zheng MH, Shi KQ, Fan YC, et al. A Model to Determine 3-Month Mortality Risk in Patients With Acute-on-Chronic Hepatitis B Liver Failure. Clin Gastroenterol Hepatol, 2011, 9 :351-356.
[13] Namendys-Silva SA, Texcocano-Becerra J, Herrera-Gomez A. Application of the Sequential Organ Failure Assessment (SOFA) score to patients with cancer admitted to the intensive care unit. Am J Hosp Palliat Care, 2009, 26 :341-346.

[1]	王建文, 刘大东, 马鸿杰. 慢加急性肝衰竭合并侵袭性真菌感染患者的临床特征和预后影响因素分析[J]. 肝脏, 2020, 25(5): 507-509.
[2]	王敏. 肝癌患者自发性破裂出血的影响因素及预后因素分析[J]. 肝脏, 2020, 25(5): 510-513.
[3]	刘栋, 苏康乐, 张翠杰, 翟亚玲, 李芳华. 肾小管HBAg阳性表达与HBV相关肾功能损伤预后的关系[J]. 肝脏, 2020, 25(4): 372-374.
[4]	高朋彬, 郑欢伟, 赵晓彦, 王德华, 秦浩, 孟明辉, 张建集, 闫双缓. 内科综合治疗HBV-ACLF患者的临床特点及转归[J]. 肝脏, 2020, 25(4): 375-378.
[5]	赵梦, 陈明, 王丽, 胡孙裔. 自身免疫性肝炎患儿临床特点与预后[J]. 肝脏, 2020, 25(4): 379-381.
[6]	王雨, 许达峰, 周开伦, 武金才, 丁驿超, 古海强, 谢明微, 林明花. TLR4和肠道菌群在原发性肝癌进展中动态变化及与预后的关系[J]. 肝脏, 2020, 25(3): 273-276.
[7]	余守江, 王国兴, 马兰芳. TACE联合微波消融对原发性肝癌患者肿瘤组织灌注、免疫功能及预后的影响[J]. 肝脏, 2020, 25(3): 294-296.
[8]	李亚飞, 闫华楠, 韩少静, 郭永泽, 韩书香, 李淑霞, 吉丽, 张宏伟. 老年急性药物性肝损伤临床特征及预后影响因素分析[J]. 肝脏, 2020, 25(3): 319-322.
[9]	原庆会, 何伟. Vimentin在肝细胞癌组织中的表达及其与临床预后的关系[J]. 肝脏, 2020, 25(2): 199-201.
[10]	袁宏香, 张秋云, 娄金丽, 于艳华, 赵艳. 慢加急性肝衰竭血小板减少患者血栓弹力图及常规凝血指标的变化[J]. 肝脏, 2020, 25(1): 20-23.
[11]	贾瑾堂, 施文娟, 王兆勋, 田鹏飞. 乙型肝炎慢加急性肝衰竭患者血清γ干扰素水平变化的意义[J]. 肝脏, 2020, 25(1): 61-62.
[12]	张志侨, 叶一农, 何纲, 王鹏, 李静, 吴兴柳. 乙型肝炎相关慢加急性肝衰竭患者急性肾损伤的影响因素和高危人群分析[J]. 肝脏, 2019, 24(9): 997-1001.
[13]	刘亚迪, 孙双双, 徐浩, 李成忠. HBV相关慢加急性肝衰竭患者感染特点及危险因素分析[J]. 肝脏, 2019, 24(9): 1015-1019.
[14]	刘莉, 吕蓉蓉, 陈光耀, 邹佳丽, 盛佳琪. 35例小儿肝功能衰竭PE联合CVVHDF技术治疗的疗效及预后分析[J]. 肝脏, 2019, 24(9): 1028-1031.
[15]	诸海军, 万健, 孙莲娜, 孙杰, 陈嵩. WBC、IL-6及NLR值对慢加急性肝衰竭患者的早期预警价值[J]. 肝脏, 2019, 24(9): 1076-1078.