Value of MELD 3.0， MELD， and MELD-Na scores in assessing the short-term prognosis of patients with acute-on-chronic liver failure： A comparative study
10.3969/j.issn.1001-5256.2023.11.018
- VernacularTitle:MELD 3.0、MELD和MELD-Na评分对慢加急性肝衰竭患者短期预后的评估价值
- Author:
Beichen GUO
1
;
Yuhan LI
1
;
Rui CHEN
1
;
Lewei WANG
1
;
Ying LI
2
;
Fang LIU
2
;
Manman XU
3
;
Yu CHEN
3
;
Zhongping DUAN
3
;
Shaojie XIN
4
;
Tao HAN
1
Author Information
1. Department of Gastroenterology and Hepatology， Tianjin Union Medical Center， Tianjin Medical University， Tianjin 300121， China
2. Department of Gastroenterology and Hepatology， Tianjin Third Central Hospital， Tianjin 300170， China
3. Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research， Beijing YouAn Hospital， Capital Medical University， Beijing 100069， China
4. Department of Liver Diseases， The Fifth Medical Center of Chinese PLA General Hospital， Beijing 100039， China
- Publication Type:Journal Article
- Keywords:
Acute-On-Chronic Liver Failure;
MELD-Na Score;
MELD 3.0 Score;
MELD Score;
Prognosis
- From:
Journal of Clinical Hepatology
2023;39(11):2635-2642
- CountryChina
- Language:Chinese
-
Abstract:
ObjectiveTo investigate the value of MELD 3.0， MELD， and MELD-Na scores in assessing the 90-day prognosis of patients with acute-on-chronic liver failure （ACLF） through a comparative study. MethodsA retrospective analysis was performed for the clinical data of 605 patients with ACLF who were treated in Tianjin Third Central Hospital， The Fifth Medical Center of Chinese PLA General Hospital， and Beijing YouAn Hospital from November 2012 to June 2019， and according to the 90-day follow-up results after admission， they were divided into survival group with 392 patients and death group with 213 patients. The receiver operating characteristic （ROC） curve， the area under the ROC curve （AUC）， net reclassification improvement （NRI）， integrated discrimination improvement （IDI）， and decision curve analysis （DCA） curve were used to investigate the value of MELD 3.0， MELD， and MELD-Na scores at baseline， day 3， week 1， and week 2 in predicting the prognosis of the disease. ResultsAt day 3 and week 1， MELD 3.0 score had an AUC of 0.775 and 0.808， respectively， with a better AUC than MELD score （P<0.05）. At day 3， week 1， and week 2， MELD 3.0 score showed an NRI of 0.125， 0.100， and 0.081， respectively， compared with MELD in predicting the prognosis of ACLF patients， as well as an NRI of 0.093， 0.140， and 0.204， respectively， compared with MELD-Na score in predicting prognosis. At baseline， day 3， week 1， and week 2， MELD 3.0 showed an IDI of 0.011， 0.025， 0.017， and 0.013， respectively， compared with MELD in predicting the prognosis of ACLF patients. At day 3 and week 2， MELD 3.0 showed an IDI of 0.027 and 0.038， respectively， compared with MELD-Na in predicting the prognosis of ACLF patients. All the above NRIs and IDIs were >0， indicating a positive improvement （all P<0.05）. DCA curves showed that MELD 3.0 was superior to MELD at day 3 and was significantly superior to MELD-Na at week 2. There was no significant difference in the ability of the three scores in predicting the prognosis of ACLF patients with different types， and there was also no significant difference in the ability of the three scores in predicting the prognosis of ACLF patients with the etiology of HBV infection， alcohol， or HBV infection combined with alcohol， while MELD 3.0 was superior to MELD for ACLF patients with other etiologies （P<0.05）. ConclusionMELD 3.0 score is better than MELD and MELD-Na scores in predicting the 90-day survival of patients with ACLF， but with limited superiority.
