终末期肝病模型变化率在失代偿期肝硬化患者预后分析中的价值
预后;模型;失代偿期肝硬化;生存分析,别彩群,杨冬华,汤绍辉,黄卫,通讯作者:,ValueofΔMELDinevaluatingtheprognosisofpatientswithdecompensatedcirrhosis,Cai-Qu
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别彩群, 杨冬华, 汤绍辉, 黄卫, 暨南大学附属第一医院消化内科 广东省广州市 510630
通讯作者: 杨冬华, 510630, 广东省广州市黄埔大道西613号, 暨南大学附属第一医院消化内科. thdyang@163.com
收稿日期: 2007-05-31 修回日期: 2007-10-13
Value of ΔMELD in evaluating the prognosis of patients with decompensated cirrhosis
Cai-Qun Bie, Dong-Hua Yang, Shao-Hui Tang, Wei Huang
Cai-Qun Bie, Dong-Hua Yang, Shao-Hui Tang, Wei Huang, Department of Gastroenterology, the First Affiliated Hospital of Ji’nan University, Guangzhou 510630, Guangdong Province, China
Correspondence to: Dong-Hua Yang, Department of Gastroenterology, the First Affiliated Hospital of Ji’nan University, 613 Huangpu West Road, Guangzhou 510630, Guangdong Province, China. thdyang@163.com
Received: 2007-05-31 Revised: 2007-10-13
Abstract
AIM: To assess the prognostic significance of ΔMELD (longitudinal modifications of the model for end-stage liver disease over time) in patients with decompensated liver cirrhosis.
METHODS: A cohort of 181 patients with decompensated liver cirrhosis was studied. Initial MELD and Child-Pugh score and classification were calculated at entry. MELD score was obtained for each patient according to the modified formula by Kamath. After initial assessment, all the patients had a second evaluation that was performed in the follow-up period. ΔMELD was calculated as second MELD subracted initial MELD, and divided by the time interval (months). Kaplan-Meier survival analysis was used to compare the survival in sub-groups ranked by the initial MELD, ΔMELD and Child-Pugh classification. The area under the receiver operating characteristic (ROC) curve (AUC) was used to compare initial MELD, ΔMELD and Child-Pugh classification in predicting accuracy. The variables, including gender, age, etiology and ascites were entered into a Cox proportional hazard model in survival analysis to determine the risk ratio.
RESULTS: All subgroups ranked by initial MELD, ΔMELD and Child–Pugh classification were significantly different from each other in pairwise comparisons ......
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