GEMA-Na and MELD 3.0 severity scores to address sex disparities for accessing liver transplantation: a nationwide retrospective cohort study.

IF 9.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
EClinicalMedicine Pub Date : 2024-07-18 eCollection Date: 2024-08-01 DOI:10.1016/j.eclinm.2024.102737
Manuel Luis Rodríguez-Perálvarez, Gloria de la Rosa, Antonio Manuel Gómez-Orellana, María Victoria Aguilera, Teresa Pascual Vicente, Sheila Pereira, María Luisa Ortiz, Giulia Pagano, Francisco Suarez, Rocío González Grande, Alba Cachero, Santiago Tomé, Mónica Barreales, Rosa Martín Mateos, Sonia Pascual, Mario Romero, Itxarone Bilbao, Carmen Alonso Martín, Elena Otón, Luisa González Diéguez, María Dolores Espinosa, Ana Arias Milla, Gerardo Blanco Fernández, Sara Lorente, Antonio Cuadrado Lavín, Amaya Redín García, Clara Sánchez Cano, Carmen Cepeda-Franco, José Antonio Pons, Jordi Colmenero, David Guijo-Rubio, Alejandra Otero, Alberto Amador Navarrete, Sarai Romero Moreno, María Rodríguez Soler, César Hervás Martínez, Mikel Gastaca
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引用次数: 0

Abstract

Background: The Gender-Equity Model for liver Allocation corrected by serum sodium (GEMA-Na) and the Model for End-stage Liver Disease 3.0 (MELD 3.0) could amend sex disparities for accessing liver transplantation (LT). We aimed to assess these inequities in Spain and to compare the performance of GEMA-Na and MELD 3.0.

Methods: Nationwide cohort study including adult patients listed for a first elective LT (January 2016-December 2021). The primary outcome was mortality or delisting for sickness within the first 90 days. Independent predictors of the primary outcome were evaluated using multivariate Cox's regression with adjusted relative risks (RR) and 95% confidence intervals (95% CI). The discrimination of GEMA-Na and MELD 3.0was assessed using Harrell c-statistics (Hc).

Findings: The study included 6071 patients (4697 men and 1374 women). Mortality or delisting for clinical deterioration occurred in 286 patients at 90 days (4.7%). Women had reduced access to LT (83.7% vs. 85.9%; p = 0.037) and increased risk of mortality or delisting for sickness at 90 days (adjusted RR = 1.57 [95% CI 1.09-2.28]; p = 0.017). Female sex remained as an independent risk factor when using MELD or MELD-Na but lost its significance in the presence of GEMA-Na or MELD 3.0. Among patients included for reasons other than tumours (n = 3606; 59.4%), GEMA-Na had Hc = 0.753 (95% CI 0.715-0.792), which was higher than MELD 3.0 (Hc = 0.726 [95% CI 0.686-0.767; p = 0.001), showing both models adequate calibration.

Interpretation: GEMA-Na and MELD 3.0 might correct sex disparities for accessing LT, but GEMA-Na provides more accurate predictions of waiting list outcomes and could be considered the standard of care for waiting list prioritization.

Funding: Instituto de Salud Carlos III, Agencia Estatal de Investigación (Spain), and European Union.

用 GEMA-Na 和 MELD 3.0 严重程度评分解决肝移植手术性别差异问题:一项全国性回顾性队列研究。
背景:经血清钠校正的肝脏分配性别公平模型(GEMA-Na)和终末期肝病模型 3.0(MELD 3.0)可修正肝移植(LT)的性别差异。我们旨在评估西班牙的这些不平等现象,并比较 GEMA-Na 和 MELD 3.0 的性能:全国范围内的队列研究,包括首次选择肝移植的成年患者(2016 年 1 月至 2021 年 12 月)。主要结果是前 90 天内的死亡率或因病除名。使用多变量 Cox 回归评估了主要结果的独立预测因素,并调整了相对风险 (RR) 和 95% 置信区间 (95%CI)。使用哈雷尔 c 统计量(Hc)评估了 GEMA-Na 和 MELD 3.0 的区分度:研究纳入了 6071 名患者(4697 名男性和 1374 名女性)。286名患者(4.7%)在90天时因临床病情恶化而死亡或被除名。女性接受LT治疗的比例较低(83.7% vs. 85.9%;p = 0.037),90天后死亡或因病除名的风险较高(调整后RR = 1.57 [95% CI 1.09-2.28];p = 0.017)。在使用 MELD 或 MELD-Na 时,女性性别仍是一个独立的风险因素,但在使用 GEMA-Na 或 MELD 3.0 时,女性性别失去了其重要性。在因肿瘤以外的原因纳入的患者中(n = 3606;59.4%),GEMA-Na 的 Hc = 0.753(95% CI 0.715-0.792),高于 MELD 3.0(Hc = 0.726 [95% CI 0.686-0.767;p = 0.001),显示两个模型都有足够的校准性:GEMA-Na和MELD 3.0可纠正接受LT治疗的性别差异,但GEMA-Na对候诊结果的预测更为准确,可被视为候诊优先顺序的标准:资金来源:卡洛斯三世健康研究所、西班牙国家调查局和欧盟。
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
EClinicalMedicine
EClinicalMedicine Medicine-Medicine (all)
CiteScore
18.90
自引率
1.30%
发文量
506
审稿时长
22 days
期刊介绍: eClinicalMedicine is a gold open-access clinical journal designed to support frontline health professionals in addressing the complex and rapid health transitions affecting societies globally. The journal aims to assist practitioners in overcoming healthcare challenges across diverse communities, spanning diagnosis, treatment, prevention, and health promotion. Integrating disciplines from various specialties and life stages, it seeks to enhance health systems as fundamental institutions within societies. With a forward-thinking approach, eClinicalMedicine aims to redefine the future of healthcare.
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