Model for end-stage liver disease-sodium predicts prognosis in patients with chronic severe hepatitis B / 中华外科杂志

<p><b>OBJECTIVES</b>To study the practical use of the serum sodium incorporated model for end-stage liver disease (MELD-Na) on clinic and to assess its validity by the concordance-statistic in predicting the prognosis of the patients with chronic severe hepatitis B.</p><p><b>METHODS</b>Adult patients with a diagnosis of chronic severe hepatitis B between January 2007 and December 2007 in a single center were analyzed. The serum sodium, MELD, MELD-Na, and Delta MELD-Na (Delta MELD=MELD score at 14 days after medical treatment-MELD score at admission) scores of 426 patients with chronic severe hepatitis B were calculated. The 3-month mortality in patients was measured, and the validity of the models was determined by means of the concordance-statistic.</p><p><b>RESULTS</b>The area under the receiver-operating characteristic curves of Na, MELD and MELD-Na for the occurrence of death in 3 month were 0.718, 0.875 and 0.922. The 3-month mortality of the MELD-Na scores group <25, 25-30, >30-35, >35- <40 and > or = 40 were 2.0%, 5.4%, 35.4%, 53.8% and 86.9% respectively. There was a significant difference of 3-month mortality between the five groups (P<0.05). The 3-month mortality of Delta MELD-Na> 0 group was 65.9%, and the Delta MELD-Na < or = 0 group was 15.8%. There was a significant difference of 3-month mortality between the two groups (P<0.05).</p><p><b>CONCLUSIONS</b>MELD-Na score is a valid model to predict 3-month mortality in patients with chronic severe hepatitis B. Delta MELD-Na is clinically useful parameters for predicting the therapeutic effect of chronic severe hepatitis B.</p>

Model for end-stage liver disease-sodium predicts prognosis in patients with chronic severe hepatitis B / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Serum sodium predicts prognosis in chronic severe hepatitis B and may improve the prognostic accuracy of the model for end-stage liver disease (MELD) score, but the available information is limited. The present study was undertaken to study the clinical use of the serum sodium incorporated MELD (MELD-Na) and assess its validity by the concordance (c)-statistics in predicting the prognosis of the patient with chronic severe hepatitis B.</p><p><b>METHODS</b>A total of 426 adult patients with a diagnosis of chronic severe hepatitis B between January 1, 2007, and December 31, 2007 at a single center were studied. The scores of serum sodium, MELD, MELD-Na, and DeltaMELD-Na (DeltaMELD-Na = MELD-Na at 14 days after medical treatment -MELD-Na score on admission) of the patients with chronic severe hepatitis B were calculated. The 3-month mortality in the patients was measured, and the validity of the models was determined by means of the concordance (c) statistics.</p><p><b>RESULTS</b>The average MELD, MELD-Na scores of survival group were 25.70 +/- 5.08 and 26.60 +/- 6.90, and those of dead group were 35.60 +/- 6.78 and 42.80 +/- 9.57 on admission. There was a significant difference in MELD and MELD-Na between the survival and dead groups (P < 0.01). The average DeltaMELD-Na score of the survival group was -0.97 +/- 3.51, and that of the dead group was 3.45 +/- 2.38 at 2 weeks after the treatment. There was a significant difference in DeltaMELD-Na between the survival and dead groups (P < 0.01). The areas under the receiver-operating characteristic curves of Na, MELD and MELD-Na for the occurrence of death in 3 months were 0.742, 0.875 and 0.922. The 3-month mortality of the MELD-Na scores group < 25, 25-30, 31-34, 35-40 and > 40 were 2.0%, 5.4%, 35.4%, 53.8 % and 86.9%, respectively. There was a significant difference in the 3-month mortality between the five groups (P < 0.05). The 3-month mortality of the DeltaMELD-Na > 0 group was 65.9%, and that of the DeltaMELD-Na = 0 group was 15.8%; there was a significant difference in the 3-month mortality between the two groups (P < 0.05).</p><p><b>CONCLUSIONS</b>MELD-Na score is a valid model to predict the 3-month mortality in patients with chronic severe hepatitis B. DeltaMELD-Na is a clinically useful parameter for predicting the therapeutic effect of chronic severe hepatitis B.</p>

An evaluation of the prognosis of patients with chronic severe hepatitis using a model for end-stage liver disease / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the prognosis evaluation and treatment strategy of chronic severe hepatitis (CSH) patients using a model of end-stage liver disease (MELD).</p><p><b>METHODS</b>The MELD scores of 135 CSH patients on the day of their admittance to our hospital and the DeltaMELD scores after two-weeks of medical treatment were retrospectively analyzed. They were also compared with the scores of the three-month mortality rate of the patients.</p><p><b>RESULTS</b>The mean MELD score calculated on the first day of the patients who died after their admission to the hospital was 37.00+/-6.50, while that of the living group was 25.80+/-5.20. The difference was highly significant (chi(2)=72.00, P < 0.01). MELD score after two-weeks medical treatment of the patients who died was 1.57+/-0.89, while that of the living group was -0.99+/-0.73; the difference was also highly significant (chi(2)=56.35, P < 0.01). The area under the ROC curve of MELD score (c-statistic) was 0.90, while the c-statistic for DeltaMELD score was 0.76. On the first day of their admission, when the MELD score was < 25, the three-month mortality rate was 2%; when it was 25 <or= MELD <or= 30, the three-month mortality rate was 7%; when it was 30 <MELD score < 35, the three-month mortality rate was 43%; and when MELD score >or= 35, the three-month mortality rate was 81%; the differences between these groups were all highly significant (P less than 0.01). When MELD scores were above zero, the three-month mortality was 51%, and when DeltaMELD scores were less than or equal to zero, the three-month mortality rate was 13%. All the differences were highly significant (P < 0.01).</p><p><b>CONCLUSION</b>A high MELD score and a high Delta MELD score herald high three-month mortality rates in patients with CSH. MELD is quite usable in assessing the prognosis in patients suffering CSH. The choice of treatment for the CSH patients could be made by integrating the MELD score calculated on the first day of being admitted to a hospital and the Delta MELD score after their medical treatment.</p>