MELD评分作为三级护理中心失代偿期慢性肝病伴静脉曲张出血患者死亡率预测因子的评估

IF 3.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology Pub Date : 2025-04-01 DOI:10.1016/j.aohep.2025.101873

Laura V. Cupil-Escobedo, Karina Cazarin-Chavez, María F. Higuera-De La Tijera

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引用次数: 0

摘要

简介与目的静脉曲张出血是慢性肝病患者代偿失代偿最常见的原因。血红蛋白水平被用来区分严重程度；然而，它并不可靠。本研究旨在评估MELD评分作为静脉曲张出血患者死亡率的预测指标。材料与患者本研究对消化科住院1年诊断为静脉曲张出血且入院前48小时内符合MELD评分标准的患者进行了观察性、回顾性、比较性和纵向研究。采用ROC曲线进行描述性和推断性统计。评估人口统计学变量MELD、MELD Na和MELD乳酸评分。评估初始和随访血红蛋白水平。此外，还考虑了住院天数和出院原因。结果共分析96例患者，其中女性60例，男性36例，平均年龄62±8岁。关于肝硬化的病因，酒精：48，MASLD: 18, METALD: 8，病毒：4，不明原因：6，自身免疫：16。在ROC曲线分析中，我们发现MELD、MELD Na和MELD Lactate模型对死亡率有显著的预测。MELD截断点为21.5，AUROC为0.866 (95% CI: 0.71-1.00, p= <0.001)， MELD Na截断点为20.5，AUROC为0.848 (95% CI: 0.67-1.00, p= <0.001)， MELD Lactate截断点为20.5，AUROC为0.791 （95% CI: 0.644-0.939, p= 0.003）。结论在ROC曲线分析中，MELD、MELD Na和MELD Lactate模型对死亡率具有显著的预测能力。AUROC值分别为0.866、0.848和0.791，证实了它们在临床实践中对因静脉曲张出血而失代偿的慢性肝病患者的实用性。

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Assessment of MELD Scores as Predictors of Mortality in Patients with Decompensated Chronic Liver Disease with Variceal Hemorrhage at a third-level care center.

Introduction and Objectives

The variceal hemorrhage is the most common cause of decompensation in patients with chronic liver disease. Hemoglobin level has been used to classify severity; however, it is unreliable. This study aims to evaluate MELD scores as predictors of mortality in patients with variceal hemorrhage.

Materials and Patients

An observational, retrospective, comparative, and longitudinal study was conducted on patients hospitalized in the Gastroenterology department for one year, who were admitted with a diagnosis of variceal hemorrhage and met the criteria for applying the MELD score within the first 48 hours of hospitalization. Descriptive and inferential statistics were performed using ROC curves. Demographic variables, MELD, MELD Na, and MELD Lactate scores were evaluated. The initial and follow-up hemoglobin levels were assessed. Additionally, hospitalization days and discharge reasons were considered.

Results

A total of 96 patients were analyzed (60 women and 36 men) with an average age of 62 ± 8 years. Regarding the etiology of cirrhosis, Alcohol: 48, MASLD: 18, METALD: 8, Viral: 4, Unspecified: 6, Autoimmune: 16. In the analysis of ROC curves, it was found that there was a significant mortality prediction for the MELD, MELD Na, and MELD Lactate models. The MELD cutoff of 21.5 points presented an AUROC of 0.866 (95% CI: 0.71-1.00, p= <0.001), MELD Na of 20.5 had an AUROC of 0.848 (95% CI: 0.67-1.00, p= <0.001), and the MELD Lactate cutoff of 20.5 had an AUROC of 0.791 (95% CI: 0.644-0.939, p= 0.003)

Conclusions

In the analysis of ROC curves, the MELD, MELD Na, and MELD Lactate models demonstrated a significant predictive capacity for mortality. The AUROC values were 0.866, 0.848, and 0.791 respectively, confirming their utility in clinical practice for patients with chronic liver disease admitted in the context of decompensation due to variceal bleeding.

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来源期刊

Annals of hepatology 医学-胃肠肝病学

CiteScore

7.90

自引率

2.60%

发文量

183

审稿时长

4-8 weeks

期刊介绍： Annals of Hepatology publishes original research on the biology and diseases of the liver in both humans and experimental models. Contributions may be submitted as regular articles. The journal also publishes concise reviews of both basic and clinical topics.