Analysis of Prognosis on Patients with Chronic Severe Hepatitis Treated with Plasma Exchange Using the Criterion of Model for End-stage Liver Disease / 医学研究杂志

ABSTRACT

Objective To study the clinical practical use of the model for end-stage liver disease(MELD) and assess its validity in predicting the prognosis of the.chronic severe hepatitis patients.Methods The clinical data of 391 patients with chronic severe hepatitis among 2003～2005 in our hospital were analyzed,and they were graded with MELD formula.These patients were divided into plasma exchange group and none plasma exchange group according to plasma exchange treatment or not.The death rate was observed within three months.The validity of the model in predicting the prognosis of the patients with severe hepatitis was determined by the concordance(c)-statistic.Results 236 patients died within three-months and the mortality was 60.6%.The mortality of patients in PE group whose MELD score were less than 30 and 30～40 was 25% and 75% respectively,but in non-PE group they were 42.0%,90.7% respectively,there were significant difference between PE group and non-PE group(P0.05).The optimal cut-off values of MELD to predict the prognosis of patients were 30 in PE group whose sensitivity and specificity were 66.7% and 86.4%,and its c-statistic was 0.823(95% CI 0.734～0.912);and in non-PE group they were 27,76.4%,79.1% and 0.832(95% CI 0.787～0.877) respectively.Conclusions The mortality of the patient with chronic severe hepatitis increases with the increase in the MELD score.The MELD can accurately predict the short-term prognosis of patients with chronic severe hepatitis.