具有附加标准的终末期肝病模型，用于预测慢性乙型肝炎严

StephenW

Hepatology. 2019 Dec 23. doi: 10.1002/hep.31086. [Epub ahead of print]
Model for End-stage Liver Disease with additional criteria to predict short-term mortality in severe flares of chronic hepatitis B.
Fung J1,2,3, Mak LY1, Chan AC2,3,4, Chok KS2,3,4, Wong TC2,4, Cheung TT2,3,4, Dai WC2,4, Sin SL2,4, She WH2,4, Ma KW2,4, Seto WK1,3, Lai CL1,3, Lo CM2,3,4, Yuen MF1,3.
Author information

1
    Department of Medicine, The University of Hong Kong, Hong Kong.
2
    The Liver Transplant Center, Queen Mary Hospital, Hong Kong.
3
    State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong.
4
    Department of Surgery, The University of Hong Kong, Hong Kong.

Abstract
BACKGROUND & AIMS:

The prognosis in severe acute flares of chronic hepatitis B (AFOCHB) is often unclear. The current study aimed to establish the predictive value using the MELD score for short-term mortality for severe AFOCHB.
APPROACH & RESULTS:

Patients with severe AFOCHB with bilirubin >50 umol/l, ALT >10x upper limit of normal, and INR >1.5 were included. All patients were commenced on entecavir and/or tenofovir. Laboratory results and MELD scores were pooled to calculate mortality at four time points (day 7, 14, 21, and 28). A total of 240 patients were included. Median HBV DNA was 7.77 log IU/mL (range, 4.11-10.06), and 49 (20.4%) were HBeAg-positive. The 7, 14, 21, and 28-day survival was 96.7%, 88.5%, 79.5%, and 72.8% respectively. Using pooled results derived from 4,201 blood samples, the AUROC for the MELD score to predict day 7, 14, 21, and 28 mortality was 0.909, 0.892, 0.883, and 0.871 respectively. For MELD ≤28, mortality at day 28 was low (<25%), compared to >50% mortality for MELD ≥32. For MELD 28 to 32, higher day-28 mortality was observed for 4 criteria: age ≥52 years, ALT >217 U/L, platelets <127, and abnormal baseline imaging (all p<0.001). In this MELD bracket, the 28-day mortality was 0%, 12.1%, 23.8%, 59.4%, and 78.8% for the presence of 0, 1, 2, 3, and 4 criteria respectively.
CONCLUSIONS:

MELD score at any time points can accurately predict the short-term mortality. Patients with MELD ≥28 should be worked up for liver transplantation, and those with MELD 28-32 with 3-4 at-risk criteria, or MELD ≥32 should be listed.

© 2019 by the American Association for the Study of Liver Diseases.
KEYWORDS:

MELD; acute flare; decompensation; liver failure; liver transplantation

PMID:
    31872444
DOI:
    10.1002/hep.31086

StephenW

肝病学。 2019年12月23日.doi：10.1002 / hep.31086。 [Epub提前发布]
具有附加标准的终末期肝病模型，用于预测慢性乙型肝炎严重发作的短期死亡率。
冯J1,2,3，麦LY1，陈AC2,3,4，KS2,3,4，黄TC2,4，张TT2,3,4，戴WC2,4，仙SL2,4，佘WH2,4 ，马KW2,4，Seto WK1,3，赖CL1,3，Lo CM2,3,4，Yen MF1,3。
作者信息

1个
香港大学医学系，香港。
2
香港玛丽医院肝移植中心。
3
香港大学，肝脏研究国家重点实验室。
4
香港大学外科系。

抽象
背景与目的：

慢性乙型肝炎（AFOCHB）的严重急性发作的预后通常不清楚。当前的研究旨在使用MELD评分确定严重AFOCHB的短期死亡率的预测价值。
方法和结果：

包括重度AFOCHB，胆红素> 50 umol / l，ALT>正常上限10倍，INR> 1.5的患者。所有患者均开始使用恩替卡韦和/或替诺福韦治疗。合并实验室结果和MELD分数​​，以计算四个时间点（第7、14、21和28天）的死亡率。总共包括240名患者。 HBV DNA中位数为7.77 log IU / mL（范围4.11-10.06），HBeAg阳性49（20.4％）。 7、14、21和28天生存率分别为96.7％，88.5％，79.5％和72.8％。使用从4,201个血液样本中得出的汇总结果，MELD评分的AUROC预测第7、14、21和28天的死亡率分别为0.909、0.892、0.883和0.871。对于MELD≤28，第28天的死亡率较低（<25％），而MELD≥32的死亡率则为> 50％。对于MELD 28到32，在4个标准中观察到更高的28天死亡率：年龄≥52岁，ALT> 217 U / L，血小板<127和基线成像异常（所有p <0.001）。在此MELD等级中，存在0、1、2、3和4个标准时，28天死亡率分别为0％，12.1％，23.8％，59.4％和78.8％。
结论：

在任何时间点的MELD评分都可以准确预测短期死亡率。 MELD≥28的患者应接受肝移植的治疗，而MELD 28-32的风险标准为3-4或MELD≥32的患者应列出。

©2019美国肝病研究协会版权所有。
关键字：

融合;急性耀斑代偿肝衰竭肝移植

PMID：
31872444
DOI：
10.1002 /说明31086