天津医药

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MELD、MELD-Na、SOFA评分系统对肝衰竭短期预后的价值

李晓爽1,吕洪敏2,泽塔多吉1,李凤惠3,王芳，4,向慧玲2   

  1. 1. 天津医科大学研究生院
    2. 天津市第三中心医院
    3. 天津医科大学
    4. 天津市第三中心医院消化内科
  • 收稿日期:2011-11-11 修回日期:2012-04-03 出版日期:2012-09-15 发布日期:2012-09-15
  • 通讯作者: 吕洪敏

Value of MELD,MELD-Na and SOFA score for Prediction of Liver Failure

  • Received:2011-11-11 Revised:2012-04-03 Published:2012-09-15 Online:2012-09-15

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摘要： 摘要 目的：比较终末期肝病模型（MELD）、MELD-Na模型（MELD-Na+）、序贯器官衰竭估计（SOFA）评分系统对预测肝功能衰竭患者短期（3个月）预后的价值。方法：收集290例各型肝衰竭患者资料,对MELD、MELD-Na及SOFA评分做回顾性分析，并将290例肝衰竭患者分成生存组和死亡组，应用受试者工作特征曲线（ROC）曲线下面积评价三者对肝衰竭短期预后的预测价值，并观察3个月内的病死率。结果：290例肝衰竭患者3个月死亡率达50.7%，生存组患者MELD、MELD-Na和 SOFA 评分分别为20.2±5.0、23.8±7.8和6.9±1.7，死亡组患者MELD、MELD-Na和SOFA评分分别为26.1±8.0、33.1±12.4和9.7±2.9，各评分系统两组间比较差异有统计学意义（p<0.01）；在判断患者预后的ROC曲线AUC比较中，SOFA评分（0.805）>MELD-Na 评分（0.732）>MELD 评分（0.714），各组间差异有统计学意义，其各自的临界值（cut-off 值）分别是7.50、28.14、25.01。结论：MELD-Na、MELD 和SOFA评分均能较好地预测肝衰竭患者短期临床预后，SOFA评分系统对肝衰竭预后判断的价值更高。

关键词: 肝功能衰竭, 预后, MELD-Na, MELD, SOFA

Abstract: Abstract Objective：To investigate the value of model for End-stage Liver Disease (MELD) score , MELD with incorporation of serum sodium(MELD-Na)score and the sequential organ failure assessment (SOFA) score for evaluation of prognosis of liver failure. Methods: A total of 290 consecutive patients with liver failure were included in the study and divided into two groups according to the prognosis .The MELD, MELD-Na and SOFA were calculated respectively and comparative analysis were performed . Areas under the receiver operating characteristic curve (AUC-ROC) of MELD , MELD-Na and SOFA were used to assess the prognosis of patients with LF . Results: The mortality of LF was 50.3% in this study. MELD, MELD-Na and SOFA were significantly higher in the death group than in the survival group (26.1±8.0 vs 20.2±5.0,33.1±12.4 vs 23.8±7.8, 9.7±2.9 vs 6.9±1.7, all p < 0.01). The area under curve （AUC）values generated by the ROC curves for SOFA score were higher （AUC=0.805）than those of MELD-Na score (AUC=0.732) and MELD score (AUC=0.714) respectively. The cut-off scores of three systems were 7.50, 28.14, 25.01 respectively, which could discriminate higher and lower mortality accurately. Conclusion：MELD,MELD-Na scores and SOFA have appreciable value to evaluate the prognosis of LF patients. SOFA is more accurate than MELD and MELD-Na scores in assessing prognosis of LF patients. Key words：liver failure1 prognosis2 MELD3 MELD-Na4 SOFA5

Key words: liver failure, prognosis, MELD, MELD-Na, SOFA