MELD、MELD-Na评分及KCH标准对妊娠期急性肝衰竭患者预后的评估价值

韩璞青; 孙嫣

doi:10.3969/j.issn.1001-5256.2018.07.028

MELD、MELD-Na评分及KCH标准对妊娠期急性肝衰竭患者预后的评估价值

DOI: 10.3969/j.issn.1001-5256.2018.07.028

韩璞青,
孙嫣

广州医科大学附属第三医院消化内科

详细信息

中图分类号: R714.255
计量
- 文章访问数: 1854
- HTML全文浏览量: 33
- PDF下载量: 356
- 被引次数: 0
出版历程
- 收稿日期: 2018-01-24
- 出版日期: 2018-07-20

Value of MELD score, MELD-Na score, and King's College Hospital criteria in evaluating the prognosis of patients with acute liver failure of pregnancy

Han PuQing,
Sun Yan

Department of Gastroenterology, The Third Affiliated Hospital of Guangzhou Medical University

摘要

摘要:
目的探讨MELD、MELD-Na评分及欧洲皇家学院医院标准（KCH标准）对妊娠期急性肝衰竭患者的预后评估价值。方法选取广州医科大学附属第三医院2010年1月1日-2017年6月30日以妊娠合并急性肝衰竭为首要诊断入院的妊娠期患者50例,根据预后情况分为死亡组和生存组,根据MELD、MELD-Na及KCH标准对患者进行评分,评估不同模型与患者预后转归的关系。计量资料两组间比较采用t检验或Mann-Whithey U检验;计数资料组间比较采用χ2检验。绘制受试者工作特征曲线（ROC曲线）,计算各模型的敏感度、特异度、阳性预测值和阴性预测值,用ROC曲线下面积（AUC）衡量3种模型对妊娠期肝衰竭患者预后的预测价值。结果 50例妊娠期急性肝衰竭患者中,死亡14例,生存36例,病死率为28.0%。与生存组入院时比较,死亡组MELD评分[（39.66±5.17）分vs（29.63±6.19）分]、MELD-Na评分[（43.89±9.85）分vs（31.32±7.29）分]均明显升高（t值分别为5.36、4.94,P值均<0.05）;入院3 d后,死亡组患者MELD评分...
- 肝功能衰竭,急性 /
- 妊娠 /
- 预后
Abstract:
Objective To investigate the value of the Model for End-Stage Liver Disease ( MELD) score, MELD combined with serum sodium concentration ( MELD-Na) score, and King's College Hospital ( KCH) criteria in evaluating the prognosis of patients with acute liver failure ( ALF) of pregnancy. Methods A total of 50 patients who were admitted to the Third Affiliated Hospital of Guangzhou Medical University from January 1, 2010 to June 30, 2017 with ALF of pregnancy as the initial diagnosis were enrolled, and according to prognosis, they were divided into death group and survival group. The patients were evaluated using the MELD score, MELD-Na score, and KCH criteria, and the association between these models and prognosis was analyzed. The t-test or Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic ( ROC) curve was plotted; the sensitivity, specificity, positive predictive value, and negative predictive value of each model were calculated; the area under the ROC curve ( AUC) was used to analyze the value of these three models in predicting the prognosis of patients with ALF of pregnancy. Results Of all 50 patients, 14 died and 36 survived, resulting in a mortality rate of 28. 0%. Compared with the survival group on admission, the death group had significant increases in MELD score ( 39. 66 ± 5. 17 vs 29. 63 ± 6. 19, t = 5. 36, P <0. 05) and MELD-Na score ( 43. 89 ± 9. 85 vs 31. 32 ± 7. 29, t = 4. 94, P < 0. 05) . On day 3 after admission, the death group had significantly higher MELD score and MELD-Na score than the survival group ( MELD score: 44. 24 ± 3. 96 vs 28. 74 ± 3. 84, t =-12. 68, P <0. 05; MELD-Na score: 46. 34 ± 5. 14 vs 32. 42 ± 4. 95, t =-8. 82, P < 0. 05) . There was no significant difference in mortality rate between the patients who met the KCH criteria and those who did not ( 8/25 vs 6/25, χ2= 0. 397, P = 0. 754) . The ROC curve analysis showed that baseline MELD score had an AUC of 0. 885 ( 95% confidence interval [CI]: 0. 781-0. 988, P < 0. 01) , a sensitivity of71. 4%, and a specificity of 94. 4%; MELD-Na score had an AUC of 0. 873 ( 95% CI: 0. 764-0. 982, P < 0. 01) , a sensitivity of78. 6%, and a specificity of 88. 9%; KCH criteria had an AUC of 0. 548 ( 95% CI: 0. 392-0. 670, P < 0. 05) , a sensitivity of 57. 1%, and a specificity of 52. 7%. Baseline MELD score and MELD-Na score were divided into groups according to the cut-off value of ROC curve, and the analysis showed that the mortality rate of patients increased with the increases in MELD score and MELD-Na score ( χ2=21. 337 and 17. 294, both P < 0. 001) . Conclusion MELD score, MELD-Na score, and KCH criteria can predict the prognosis of patients with ALF of pregnancy, and MELD score and MELD-Na score have a better clinical value than the KCH criteria.
- liver failure, acute /
- pregnancy /
- prognosis

HTML全文

参考文献(24)

[1]CHENG JX, SUN LH, ZHANG YX.Research progress on prognosis evaluation of liver failure[J].Chin J Clin Infect Dis, 2014, 7 (2) :188-192. (in Chinese) 程家喜, 孙丽华, 张跃新.肝衰竭预后评估的研究进展[J].中华临床感染病杂志, 2014, 7 (2) :188-192.

[2] JASHNANI KD, RUPANI AB, WANI RJ.Maternal mortality:An autopsy audit[J].J Postgrad Med, 2009, 55 (1) :12-16.

[3] Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, CMA;Severe Liver Diseases and Artificial Liver Group, Chinese Society of Hepatology, CMA.Guideline for diagnosis and treatment of liver failure (2012 version) [J].Chin J Clin Infect Dis, 2012, 5 (6) :321-327. (in Chinese) 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南 (2012年版) [J].中华临床感染病杂志, 2012, 5 (6) :321-327.

[4]KAMATH PS, WIESNER RH, MALINCHOC M, et al.A model to predict survival in patients with end-stage liver disease[J].Hepatology, 2001, 33 (2) :464-470.

[5]BIGGINS SW, KIM WR, TERRAULT NA, et al.Evidence-based incorporation of serum sodium concentration into MELD[J].Gastroenterology, 2006, 130 (6) :1652-1660.

[6] O'GRADY JG, ALEXANDER GJ, HAYLLAR KM, et al.Early indicators of prognosis in fulminant hepatic failure[J].Gastroenterology, 1989, 97 (2) :439-445.

[7] USTA IM, BARTON JR, AMON EA, et al.Acute fatty liver of pregnancy:An experience in the diagnosis and management of fourteen cases[J].Am J Obstet Gynecol, 1994, 171 (5) :1342-1347.

[8] SIBAI BM, RAMADAN MK, USTA I, et al.Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome) [J].Am J Obstet Gynecol, 1993, 169 (4) :1000-1006.

[9] ROBERTS JM, REDMAN CW.Pre-eclampsia:More than pregnancy-induced hypertension[J].Lancet, 1993, 341 (8858) :1447-1451.

[10]XIONG HF, LIU JY, GUO LM, et al.Acute fatty liver of pregnancy:Over six months follow-up study of twenty-five patients[J].World J Gastroenterol, 2015, 21 (6) :1927-1931.

[11]KOO JK, KIM JH, CHOI YJ, et al.Predictive value of Refit Model for End-Stage Liver Disease, Refit Model for End-Stage Liver Disease-Na, and pre-existing scoring system for 3-month mortality in Korean patients with cirrhosis[J].J Gastroenterol Hepatol, 2013, 28 (7) :1209-1216.

[12] DHIMAN RK, JAIN S, MAHESHWARI U, et al.Early indicators of prognosis in fulminant hepatic failure:An assessment of the Model for End-Stage Liver Disease (MELD) and King's College Hospital criteria[J].Liver Transpl, 2007, 13 (6) :814-821.

[13]SHI XX, ZHANG YQ, ZHU P, et al.Prognostic risk factors in patients with hepatitis B virus-related acute-on-chronic liver failure[J].J Clin Hepatol, 2016, 32 (4) :700-705. (in Chinese) 石新星, 张艳琼, 朱鹏, 等.乙型肝炎相关慢加急性肝衰竭患者预后的危险因素分析[J].临床肝胆病杂志, 2016, 32 (4) :700-705.

[14]Mc PHAIL MJ, FARNE H, SENVAR N, et al.Ability of King's College Criteria and Model for End-Stage Liver Disease Scores to predict mortality of patients with acute liver failure:A meta-analysis[J].Clin Gastroenterol Hepatol, 2016, 14 (4) :516-525.

[15]CHOLONGITAS E, THEOCHARIDOU E, VASIANOPOULOU P, et al.Comparison of the sequential organ failure assessment score with the King's College Hospital criteria and the model for end-stage liver disease score for the prognosis of acetaminophen-induced acute liver failure[J].Liver Transpl, 2012, 18 (4) :405-412.

[16]DENG LZ, LI XM, CHEN DJ, et al.Then effect of MELD scoring system for predicting the short-term prognosis of pregnancy complicating fulminant hepatitis[J].Chin J Prac Gynecol Obstetr, 2010, 26 (3) :209-212. (in Chinese) 邓柳枝, 李小毛, 陈敦金, 等.终末期肝病模型评分对妊娠合并重型肝炎短期预后的评价作用[J].中国实用妇科与产科杂志, 2010, 26 (3) :209-212.

[17]MURALI AR, DEVARBHAVI H, VENKATACHALA PR, et al.Factors that predict 1-month mortality in patients with pregnancy-specific liver disease[J].Clin Gastroenterol Hepatol, 2014, 12 (1) :109-113.

[18]WESTBROOK RH, YEOMAN AD, O'GRADY JG, et al.Model for end-stage liver disease score predicts outcome in cirrhotic patients during pregnancy[J].Clin Gastroenterol Hepatol, 2011, 9 (8) :694-699.

[19]von DADELSZEN P, PAYNE B, LI J, et al.Prediction of adverse maternal outcomes in pre-eclampsia:Development and validation of the full PIERS model[J].Lancet, 2011, 377 (9761) :219-227.

[20] LI C, YOU SL, LIU HL, et al.The value of the baseline MELD scores, MELD-Na scores and i MELD scores in short-tern prognosis in hepatitis B virus related acute-on-chronic liver failure patients[J].Chin Crit Care Med, 2014, 26 (8) :539-543. (in Chinese) 李晨, 游绍莉, 刘鸿凌, 等.基线MELD、MELD-Na、i MELD 3种模型对乙型肝炎病毒相关慢加急性肝衰竭患者近期预后的评估价值[J].中华危重病急救医学, 2014, 26 (8) :539-543.

[21]LI XS, LYU HM, LI FH, et al.Values of MELD, MELD-Na and SOFA scores for prediction of liver failure[J].Tianjin Med J, 2012, 40 (9) :902-904. (in Chinese) 李晓爽, 吕洪敏, 李凤惠, 等.MELD、MELD-Na、SOFA评分系统对肝衰竭短期预后的价值[J].天津医药, 2012, 40 (9) :902-904.

[22]FENG HL, LI Q, WANG L, et al.Indocyanine green clearance test combined with MELD score in predicting the short-term prognosis of patients with acute liver failure[J].Hepatobiliary Pancreat Dis Int, 2014, 13 (3) :271-275.

[23]DU WB, PAN XP, LI LJ.Prognostic models for acute liver failure[J].Hepatobiliary Pancreat Dis Int, 2010, 9 (2) :122-128.

[24] SHIN HS, KIM SP, HAN SH, et al.Prognostic indicators for acute liver failure development and mortality in patients with hepatitis A:Consecutive case analysis[J].Yonsei Med J, 2014, 55 (4) :953-959.

施引文献

资源附件(0)

访问统计