Validation of MELD3.0 in 2 centers from different continents.

IF 5.6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Hepatology Communications Pub Date : 2024-07-31 eCollection Date: 2024-08-01 DOI:10.1097/HC9.0000000000000504

Marta Tejedor, José María Bellón, Margarita Fernández de la Varga, Peregrina Peralta, Eva Montalvá, Nazia Selzner, Marina Berenguer

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引用次数: 0

Abstract

Background: MELD3.0 has been proposed to stratify patients on the liver transplant waiting list (WL) to reduce the historical disadvantage of women in accessing liver transplant. Our aim was to validate MELD3.0 in 2 unique populations.

Methods: This study is a 2-center retrospective cohort study from Toronto, Canada, and Valencia, Spain, of all adults added to the liver transplant WL between 2015 and 2019. Listing indications whose short-term survival outcome is not adequately captured by the MELD score were excluded. All patients analyzed had a minimum follow-up of 3 months after inclusion in the WL.

Results: Six hundred nineteen patients were included; 61% were male, with a mean age of 56 years. Mean MELD at inclusion was 18.00 ± 6.88, Model for End-Stage Liver Disease Sodium (MELDNa) 19.78 ± 7.00, and MELD3.0 20.25 ± 7.22. AUC to predict 90-day mortality on the WL was 0.879 (95% CI: 0.820, 0.939) for MELD, 0.921 (95% CI: 0.876, 0.967) for MELDNa, and 0.930 (95% CI: 0.888, 0.973) for MELD3.0. MELDNa and MELD3.0 were better predictors than MELD (p = 0.055 and p = 0.024, respectively), but MELD3.0 was not statistically superior to MELDNa (p = 0.144). The same was true when stratified by sex, although the difference between MELD3.0 and MELD was only significant for women (p = 0.032), while no statistical significance was found in either sex when compared with MELDNa. In women, AUC was 0.835 (95% CI: 0.744, 0.926) for MELD, 0.873 (95% CI: 0.785, 0.961) for MELDNa, and 0.886 (95% CI: 0.803, 0.970) for MELD3.0; differences for the comparison between AUC in women versus men for all 3 scores were nonsignificant. Compared to MELD, MELD3.0 was able to reclassify 146 patients (24%), the majority of whom belonged to the MELD 10-19 interval. Compared to MELDNa, it reclassified 68 patients (11%), most of them in the MELDNa 20-29 category.

Conclusions: MELD3.0 has been validated in centers with significant heterogeneity and offers the highest mortality prediction for women on the WL without disadvantaging men. However, in these cohorts, it was not superior to MELDNa.

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在不同大洲的两个中心验证 MELD3.0。

背景：有人提出用 MELD3.0 对肝移植候选名单（WL）上的患者进行分层，以减少女性在接受肝移植方面的历史劣势。我们的目的是在两个独特的人群中验证 MELD3.0：本研究是一项来自加拿大多伦多和西班牙巴伦西亚的双中心回顾性队列研究，研究对象为2015年至2019年间加入肝移植候选名单的所有成人。MELD评分不能充分反映短期生存结果的上市适应症被排除在外。所有分析的患者在纳入 WL 后至少随访 3 个月：共纳入 619 名患者；61% 为男性，平均年龄为 56 岁。纳入时的平均 MELD 为 18.00 ± 6.88，终末期肝病钠模型（MELDNa）为 19.78 ± 7.00，MELD3.0 为 20.25 ± 7.22。MELD 预测 WL 90 天死亡率的 AUC 为 0.879（95% CI：0.820，0.939），MELDNa 为 0.921（95% CI：0.876，0.967），MELD3.0 为 0.930（95% CI：0.888，0.973）。与 MELD 相比，MELDNa 和 MELD3.0 的预测效果更好（分别为 p = 0.055 和 p = 0.024），但 MELD3.0 在统计学上并不优于 MELDNa（p = 0.144）。按性别分层时也是如此，尽管 MELD3.0 和 MELD 之间的差异仅对女性有显著性（p = 0.032），而与 MELDNa 相比，男女均无统计学意义。在女性中，MELD 的 AUC 为 0.835（95% CI：0.744, 0.926），MELDNa 为 0.873（95% CI：0.785, 0.961），MELD3.0 为 0.886（95% CI：0.803, 0.970）；女性与男性所有 3 个评分的 AUC 比较差异均不显著。与 MELD 相比，MELD3.0 能对 146 名患者（24%）进行重新分类，其中大部分患者属于 MELD 10-19 分区间。与 MELDNa 相比，MELD3.0 对 68 名患者（11%）进行了重新分类，其中大部分患者属于 MELDNa 20-29 级：结论：MELD3.0已在具有显著异质性的中心进行了验证，对WL上的女性死亡率预测最高，而对男性则没有不利影响。然而，在这些队列中，MELD3.0并不优于MELDNa。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hepatology Communications GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

8.00

自引率

2.00%

发文量

248

审稿时长

8 weeks

期刊介绍： Hepatology Communications is a peer-reviewed, online-only, open access journal for fast dissemination of high quality basic, translational, and clinical research in hepatology. Hepatology Communications maintains high standard and rigorous peer review. Because of its open access nature, authors retain the copyright to their works, all articles are immediately available and free to read and share, and it is fully compliant with funder and institutional mandates. The journal is committed to fast publication and author satisfaction.