评价meld 3.0评分对肝硬化合并急性静脉曲张出血患者死亡率的预测价值。

IF 3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinical and Translational Gastroenterology Pub Date : 2025-08-22 DOI:10.14309/ctg.0000000000000909

Tram Que Nguyen Pham, Thong Duy Vo

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引用次数: 0

摘要

简介：急性静脉曲张出血（AVB）是肝硬化的严重并发症，6周死亡率高达15-20%。早期风险预测对指导管理至关重要。MELD 3.0是原始MELD评分的改进版本，纳入了额外的变量（性别、钠、白蛋白、上限肌酐），以改善短期死亡率预测。本研究评估了MELD 3.0与MELD、Glasgow-Blatchford评分（GBS）和AIMS65相比在预测肝硬化AVB患者6周死亡率方面的效用。方法：对Cho Ray医院（2023年11月- 2024年5月）住院的肝硬化AVB患者进行前瞻性队列研究。主要终点为6周死亡率；住院死亡率次之。采用AUCROC评估MELD 3.0、MELD、GBS和AIMS65的预测性能。结果：212例患者住院死亡率为4.7%，6周死亡率为19.8%。对于院内死亡率，MELD 3.0的AUC最高（0.88），其次是MELD（0.80）、AIMS65（0.74）和GBS（0.59）。对于6周死亡率，MELD 3.0再次优于其他方法（AUC: 0.81），而MELD (0.75), AIMS65（0.66）和GBS(0.61)（均p < 0.05）。MELD 3.0临界值≥20预测bb0 25%的6周死亡率（敏感性69.1%，特异性83.5%）。结论：MELD 3.0是肝硬化合并AVB患者早期死亡率的有力预测因子。临界值≥20可能有助于识别需要及时重症监护的高危患者。

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EVALUATING THE PROGNOSTIC VALUE OF THE MELD 3.0 SCORE IN PREDICTING MORTALITY IN CIRRHOSIS PATIENTS WITH ACUTE VARICEAL BLEEDING.

Introduction: Acute variceal bleeding (AVB) is a severe complication of cirrhosis, with a 6-week mortality rate of up to 15-20%. Early risk prediction is essential for guiding management. MELD 3.0, a refined version of the original MELD score, incorporates additional variables (gender, sodium, albumin, capped creatinine) to improve short-term mortality prediction. This study assessed MELD 3.0's utility in predicting 6-week mortality in cirrhotic patients with AVB, in comparison with MELD, Glasgow-Blatchford Score (GBS), and AIMS65.

Methods: A prospective cohort of cirrhotic patients with AVB admitted to Cho Ray Hospital (Nov 2023-May 2024) was studied. The primary outcome was 6-week mortality; in-hospital mortality was secondary. The predictive performance of MELD 3.0, MELD, GBS, and AIMS65 was evaluated using AUCROC.

Results: Among 212 patients, in-hospital and 6-week mortality rates were 4.7% and 19.8%, respectively. For in-hospital mortality, MELD 3.0 showed the highest AUC (0.88), followed by MELD (0.80), AIMS65 (0.74), and GBS (0.59). For 6-week mortality, MELD 3.0 again outperformed others (AUC: 0.81), vs. MELD (0.75), AIMS65 (0.66), and GBS (0.61) (all p < 0.05). A MELD 3.0 cut-off ≥ 20 predicted >25% 6-week mortality (sensitivity 69.1%, specificity 83.5%).

Conclusion: MELD 3.0 is a strong predictor of early mortality in cirrhotic patients with AVB. A cut-off ≥ 20 may help identify high-risk patients requiring prompt intensive care.

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来源期刊

Clinical and Translational Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

7.00

自引率

0.00%

发文量

114

审稿时长

16 weeks

期刊介绍： Clinical and Translational Gastroenterology (CTG), published on behalf of the American College of Gastroenterology (ACG), is a peer-reviewed open access online journal dedicated to innovative clinical work in the field of gastroenterology and hepatology. CTG hopes to fulfill an unmet need for clinicians and scientists by welcoming novel cohort studies, early-phase clinical trials, qualitative and quantitative epidemiologic research, hypothesis-generating research, studies of novel mechanisms and methodologies including public health interventions, and integration of approaches across organs and disciplines. CTG also welcomes hypothesis-generating small studies, methods papers, and translational research with clear applications to human physiology or disease. Colon and small bowel Endoscopy and novel diagnostics Esophagus Functional GI disorders Immunology of the GI tract Microbiology of the GI tract Inflammatory bowel disease Pancreas and biliary tract Liver Pathology Pediatrics Preventative medicine Nutrition/obesity Stomach.