急性发作，慢性肝功能衰竭终末期肝病模型评分改变在两个

StephenW

Change in model for end-stage liver disease score at two weeks, as an indicator of mortality or liver transplantation at 60 days in acute-on-chronic liver failure

    Rajneesh Kumar*,
    Thinesh Lee Krishnamoorthy,
    Hiang Keat Tan,
    Hock Foong Lui and
    Wan Cheng Chow

+ Author Affiliations

    Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore

    ↵*Corresponding author. Department of Gastroenterology and Hepatology, Singapore General Hospital, Outram Road, Singapore 169608. Tel: +65-65767661; Fax: +65-62273623; Email: [email protected]

    Received August 19, 2014.
    Revision received October 1, 2014.
    Accepted October 11, 2014.

Abstract

Background. Acute-on-chronic liver failure (ACLF) is characterised by a sudden deterioration of underlying chronic liver disease, resulting in increased rates of mortality and liver transplantation. Early prognostication can benefit optimal allocation of resources.

Methods. ACLF was defined as per the disease criteria of the Asian Pacific Association for the Study of the Liver. Inpatient discharge summaries from between January 2001 and April 2013 were reviewed. The primary outcome was mortality or liver transplantation within 60 days from onset of ACLF. Absolute ‘model for end-stage liver disease' (MELD) score and change in MELD at Weeks 1, 2 and 4 were reviewed in order to identify the earliest point for prediction of mortality or liver transplantation.

Results. Clinical data were collected on 53 subjects who fulfilled the inclusion and exclusion criteria. At 60 days from presentation, 20 patients (37.7%) died and 4 (7.5%) underwent liver transplantation. Increased MELD of ≥2 after 2 weeks was 75.0% sensitive and 75.9% specific for predicting mortality or liver transplantation. If the MELD score did not increase at 2 weeks, predictive chance of survival was 93.8% over the next 60 days. MELD change at 1 week showed poor sensitivity and specificity. Change at 4 weeks was too late for intervention.

Conclusion. Change in MELD score at 2 weeks provides an early opportunity for prognostication in ACLF. A MELD score that does not deteriorate by Week 2 would predict 93.8% chance of survival for the next 60 days. This finding warrants further validation in larger cohort studies.
Key words

    acute-on-chronic liver failure
    model for end-stage liver disease (MELD) score
    liver transplantation
    mortality

    © The Author(s) 2014. Published by Oxford University Press and the Digestive Science Publishing Co. Limited.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

StephenW

模型为终末期肝病评分改变在两个星期内，如死亡或肝移植的一个指标，在60天的急性发作，慢性肝功能衰竭

    罗杰尼希库马尔*，
    Thinesh李Krishnamoorthy，
    HIANG吉檀，
    永丰飞吕和
    万砗嗯周

+作者机构

    胃肠病学和肝病，新加坡中央医院，新加坡科

    ↵*通讯作者。胃肠病学和肝病，新加坡中央医院，欧南路，新加坡部169608.电话：+65-65767661;传真：+65-62273623;电子邮件：[email protected]

    收到2014年8月19日。
    修订收到2014年10月1日。
    接受二零一四年十月一十一日。

抽象

背景。急性上慢性肝衰竭（ACLF）的特征是潜在的慢性肝病的突然恶化，造成的死亡率和肝移植的速率增加。早期的预测可以受益资源的优化配置。

方法。 ACLF定义为每疾病亚太协会的标准对肝脏的研究。从2001年1月和2013年4月间住院出院小结进行了审查。主要终点为死亡或肝移植内ACLF发病60天。绝对“模式终末期肝病'（MELD）评分和变化MELD在周1，2和4，以查明死亡或肝移植的预测最早点审查。

结果。临床资料收集于53科目谁符合纳入和排除标准。从演讲60天后，20例（37.7％），死亡4例（7.5％）接受了肝移植。对≥22周后增加MELD为75.0％，敏感性和75.9％，特异性为预测死亡或肝移植。如果MELD评分在2周没有增加，生存几率的预测为93.8％，在接下来的60天。 MELD变化1周表现不佳的敏感性和特异性。变化4周时已经来不及干预。

结论。变化MELD评分在2周为预测ACLF中的早期机会。一个MELD评分并不受第2周下降所预测的存活率93.8％的机会在接下来的60天。这一发现还需要进一步验证在较大的队列研究。
关键词

    急性上慢性肝衰竭
    型号为终末期肝病（MELD）评分
    肝移植
    死亡

    ©作者（S）发布2014年由牛津大学出版社和消化科学出版社有限责任公司。

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