Prediction value of different scoring models in predicting the prognosis of patients with end-stage liver disease undergoing liver transplantation / 中华器官移植杂志

ABSTRACT

Objective:To explore the values of CTP score, MELD score, MELD-Na score, ALBI score and neutrophil-lymphocyte ratio (NLR) in predicting the short/long-term prognoses of patients with end-stage liver disease (ESLD) after liver transplantation (LT).Methods:From August 2015 to February 2017, basic preoperative profiles and survival status were retrospectively reviewed for 125 ESLD patients undergoing orthotopic LT.Receiver operating characteristic (ROC) curve was utilized for evaluating the capability of five scores for predicting short-term (3 months post-operation) and long-term (5 years post-operation) prognoses.Cut-off value was determined according to the Jordan index and Kaplan-Meier survival curve plotted.The difference in survival rate between upper and lower cut-off values was analyzed by Log-rank test.Results:Five-year survival rate post-LT was 69.6%(87/125), case fatality rate 30.4%(38/125) and case fatality rate within 3 months post-operation 12.8%(16/125). The AUROC values of CTP score, MELD score, MELD-Na score, ALBI score and NLR for short-term prognosis were 0.787, 0.767, 0.875, 0.801 and 0.837 and AUROC values for predicting long-term prognosis 0.744, 0.744, 0.817, 0.778 and 0.815 respectively.De Long test indicated that the capabilities of MELD-Na score for predicting short-term prognosis varied significantly from that of another four models ( P<0.05). No significant difference existed in capability of predicting long-term prognosis ( P>0.05). The cut-off values of MELD and MELD-Na scores at Month 3/60 post-LT were 20.09 vs.16.44 and 23.63 vs.17.79.The survival rates of upper and lower groups distinguished by cut-off values were 90.9% vs.50.0%, 86.5% vs.45.1% and 99.3% vs.55.6%, 93.9% vs.42.4% respectively.The differences were statistically significant ( P<0.05). Conclusions:Predictive value of MELD-Na score for short-term prognosis of LT is superior to than that of CTP, MELD score, ALBI score or NLR.However, it offers no significant superiority in predicting long-term prognoses.With a rising preoperative MELD/MELD-Na score, postoperative mortality spikes.