AIM:To determine the contributions of insulin-like growth factor 1 (IGF-1),cytokines and liver disease severity to bone mineral density in patients pre-transplantation.METHODS:Serum IGF-1,tumor necrosis factor-α (TNF...AIM:To determine the contributions of insulin-like growth factor 1 (IGF-1),cytokines and liver disease severity to bone mineral density in patients pre-transplantation.METHODS:Serum IGF-1,tumor necrosis factor-α (TNFα) and interleukin 6 (IL-6) were measured and the Model for End-Stage Liver Disease (MELD) score calculated in 121 adult patients referred to a single centre for liver transplantation.Bone mineral density (BMD) of the lumbar spine and femoral neck were assessed via dual energy X-ray absorptiometry.Demographics,liver disease etiology,medication use and relevant biochemistry were recorded.RESULTS:A total of 117 subjects were included,with low BMD seen in 68.6%,irrespective of disease etiol-ogy.In multivariable analysis,low body mass index (BMI),increased bone turnover and low IGF-1 were independent predictors of low spinal bone density.At the hip,BMI,IGF-1 and vitamin D status were predictive.Despite prevalent elevations of TNFα and IL-6,levels did not correlate with degree of bone loss.The MELD score failed to predict low BMD in this pre-transplant population.CONCLUSION:Osteopenia/osteoporosis is common in advanced liver disease.Low serum IGF-1 is weakly predictive but serum cytokine and MELD score fail to predict the severity of bone disease.展开更多
Background The model for end-stage liver disease(MELD)score is widely used for the prognostication in end-stage liver disease but has limited performance in acute-on-chronic liver failure(ACLF).In this study,we identi...Background The model for end-stage liver disease(MELD)score is widely used for the prognostication in end-stage liver disease but has limited performance in acute-on-chronic liver failure(ACLF).In this study,we identified additional predictive parameters and reformed the MELD score to predict ACLF more accurately.Methods A meta-analysis was performed on relevant studies to identify the predictive factors of 28-day/90-day outcomes of ACLF,which were validated in two large prospective cohorts.A prognostic score was developed by incorporating predictive parameters into the MELD score.The model was evaluated with a focus on discrimination and calibration.Results The meta-analysis incorporated 32 cohort studies with a total of 13939 patients,of which 13 risk factors were identified,and 3 risk factors(age,neutrophil count and hepatic encephalopathy(HE)grade)besides MELD score were validated in 751 patients with ACLF derived from two prospective cohorts.A new model(Chinese Acute-on-Chronic Liver Failure Consortium(CATCH-LIFE)-MELD score)was developed as follows:0.028×age+0.3×HE grade+0.039×neutrophil count+0.079×MELD score.CATCH-LIFE-MELD score achieved a concordance index of 0.791/0.788 for 28-day/90-day outcomes,which is superior to other traditional scores.Other discrimination indices,including net reclassification improvement,integrated discrimination improvement and probability density function,and calibration including Nagelkerke’s R2 and Brier scores confirmed its superiority.Moreover,the accuracy of CATCH-LIFE-MELD score remained stable.It was highest in patients with or without hepatitis B virus infection,cirrhosis,liver failure or under the Chinese Group on the Study of Severe Hepatitis B(COSSH)criteria or European Association for the Study of the Liver(EASL)criteria.All results were substantiated by an evaluation using an external cohort.Conclusions CATCH-LIFE-MELD score,a modified MELD score exhibited improved accuracy in predicting the short-term prognosis of ACLF than other traditional scores.展开更多
目的探讨预后营养指数(PNI)联合MELD评分评估肝硬化失代偿期患者预后的价值。方法纳入2020年1月至2023年1月合肥市第一人民医院确诊的失代偿期肝硬化患者216例,以死亡为终点事件,按照随访1年的转归情况分为生存组156例和死亡组60例,比...目的探讨预后营养指数(PNI)联合MELD评分评估肝硬化失代偿期患者预后的价值。方法纳入2020年1月至2023年1月合肥市第一人民医院确诊的失代偿期肝硬化患者216例,以死亡为终点事件,按照随访1年的转归情况分为生存组156例和死亡组60例,比较两组患者入院时PNI、CTP评分、MELD水平。运用单因素和多因素Cox回归模型预测1年死亡的独立影响因素,以ROC曲线下面积(AUC)评估PNI预测的准确性。按照约登指数计算PNI的最佳临界值,绘制Kaplan-Meier曲线分析不同PNI水平患者的1年生存率。通过二分类变量logistic回归对PNI、MELD评分进行联合预测患者1年死亡的价值。采用限制性立方样条(restricted cubic spline,RCS)拟合Cox回归模型评估不同的PNI截点与1年死亡风险的关系。结果随访1年死亡60例(27.78%),死亡组入院时PNI明显低于生存组[29.0(25.7~31.7)比36.5(30.6~41.0),P<0.001]。PNI与CTP评分、MELD评分呈负相关性(r=-0.766、-0.483,P<0.001)。PNI是患者1年死亡风险的独立影响因素(OR:0.938,95%CI:0.889~0.991,P=0.021);ROC曲线显示PNI及MELD评分预测患者1年死亡风险最佳临界值分别为33.45、16.61,AUC分别为0.780、0.871。而PNI联合MELD评分对患者1年死亡预测效率可提高至0.885(P<0.001)。RCS显示PNI和1年死亡风险呈线性关系(P for nonlinear>0.05)。结论肝硬化失代偿期患者PNI联合MELD评分能够有效预测1年死亡风险。展开更多
Background & Objectives: Hepatocellular carcinoma (HCC) leads to high morbidity and mortality. Various models have been proposed for predicting the outcome of patients with HCC. We aim to compare the prognostic ab...Background & Objectives: Hepatocellular carcinoma (HCC) leads to high morbidity and mortality. Various models have been proposed for predicting the outcome of patients with HCC. We aim to compare the prognostic abilities of Child-Pugh, MELD, MELD-Na, and ALBI scores for predicting in-hospital mortality of HCC. Methods: We enrolled patients diagnosed with liver cirrhosis and HCC from May 2017 through May 2018. We further divided eligible patients into hepatitis B virus (HBV), patients without ascites, and patients with ascites subgroups. Areas under the characteristic curves (AUCs) were analyzed. Results: A total of 495 patients were included in the study. We collected data on patients at admission. A majority of patients were infected with HBV (91.5%). None of them were complicated with hepatic encephalopathy. Only 14.9% of patients presented with ascites. In the whole population, AUCs with 95% confidence interval (CI) of Child-Pugh, ALBI, MELD, and MELD-Na scores in predicting in-hospital mortality were 0.889 (95% CI: 0.858 - 0.915), 0.849 (95% CI: 0.814 - 0.879), 0.669 (95% CI: 0.626 - 0.711), and 0.721 (95% CI: 0.679 - 0.760), respectively. In the patients without ascites subgroup, Child-Pugh showed better discriminatory ability than ALBI score in predicting in-hospital mortality (P = 0.0002), while there were no significant differences among other comparisons. Conclusions: Child-Pugh and ALBI may be useful predictors for predicting in-hospital mortality in whole patients, in patients with HBV infection, and in patients without ascites. In HCC patients with ascites, MELD-Na may be effective for predicting in-hospital mortality.展开更多
目的探讨MELD(Model For End-StageLiver Disease)评分在评估肝硬化患者预后及肝脏储备功能中方面的作用。方法分析我院从2005年8月至2009年7月收治外科病房的429例肝硬化患者的临床资料,对照MELD评分,Child-Pugh分级,肝脏体积及吲哚氰...目的探讨MELD(Model For End-StageLiver Disease)评分在评估肝硬化患者预后及肝脏储备功能中方面的作用。方法分析我院从2005年8月至2009年7月收治外科病房的429例肝硬化患者的临床资料,对照MELD评分,Child-Pugh分级,肝脏体积及吲哚氰绿(Indocyanine greenICG)试验数值,分析肝硬化患者预后情况,各个评分体系之间的关系。结果 MELD评分与Child-Pugh分级生存组与死亡组比较均有明显差异(P<0.01),MELD评分与Child-Pugh分级两体系的ROC曲线面积有差异(P<0.01)。MELD评分,Child-Pugh分级与肝脏体积有相关性(P<0.01),肝脏体积与MELD评分的相关系数大于Child-Pugh分级。Child-Pugh分级与吲哚氰绿试验指标(K值,R15)有相关性(P<0.05);MELD评分与吲哚氰绿试验指标(K值,R15)有显著相关性(P<0.01)。结论相对于传统的Child-Pugh分级,MELD评分能更好的预测患者预后,特异度,敏感度更高,精确性更好,MELD评分与肝脏体积,肝脏储备功能间存在明显相关性,且相关性明显好于Child-Pugh分级,作为评价患者预后,MELD评分体系更可靠,更能间接反映出肝脏的储备功能。展开更多
基金Supported by the Transplant Program of the University of Alberta Hospital
文摘AIM:To determine the contributions of insulin-like growth factor 1 (IGF-1),cytokines and liver disease severity to bone mineral density in patients pre-transplantation.METHODS:Serum IGF-1,tumor necrosis factor-α (TNFα) and interleukin 6 (IL-6) were measured and the Model for End-Stage Liver Disease (MELD) score calculated in 121 adult patients referred to a single centre for liver transplantation.Bone mineral density (BMD) of the lumbar spine and femoral neck were assessed via dual energy X-ray absorptiometry.Demographics,liver disease etiology,medication use and relevant biochemistry were recorded.RESULTS:A total of 117 subjects were included,with low BMD seen in 68.6%,irrespective of disease etiol-ogy.In multivariable analysis,low body mass index (BMI),increased bone turnover and low IGF-1 were independent predictors of low spinal bone density.At the hip,BMI,IGF-1 and vitamin D status were predictive.Despite prevalent elevations of TNFα and IL-6,levels did not correlate with degree of bone loss.The MELD score failed to predict low BMD in this pre-transplant population.CONCLUSION:Osteopenia/osteoporosis is common in advanced liver disease.Low serum IGF-1 is weakly predictive but serum cytokine and MELD score fail to predict the severity of bone disease.
基金supported by the National Key Research and Development Programme of China(No.2022YFC2304501,No.2021YFC2301800)Medical Health Science and Technology Project of Zhejiang Provincial Health Commission(No.2022RC141)+5 种基金the Fundamental Research Funds for the Central Universities(No.226-2023-00127,No.2021FZZX001-41)Medical and Health,Science and Technology Planning Project of Zhejiang Province,China(No.2021436801)the National Natural Science Foundation of China(81870425,81930061,81900579,81473641,81271884,81700561,81470038,82070650 and 81660333)the Shanghai Hospital Development Commission(SHDC2020CR1037B)the Chongqing Natural Science Foundation(CSTC2019jcyj-zdxmX0004)Shandong Province Natural Science Foundation(ZR2019PH052).
文摘Background The model for end-stage liver disease(MELD)score is widely used for the prognostication in end-stage liver disease but has limited performance in acute-on-chronic liver failure(ACLF).In this study,we identified additional predictive parameters and reformed the MELD score to predict ACLF more accurately.Methods A meta-analysis was performed on relevant studies to identify the predictive factors of 28-day/90-day outcomes of ACLF,which were validated in two large prospective cohorts.A prognostic score was developed by incorporating predictive parameters into the MELD score.The model was evaluated with a focus on discrimination and calibration.Results The meta-analysis incorporated 32 cohort studies with a total of 13939 patients,of which 13 risk factors were identified,and 3 risk factors(age,neutrophil count and hepatic encephalopathy(HE)grade)besides MELD score were validated in 751 patients with ACLF derived from two prospective cohorts.A new model(Chinese Acute-on-Chronic Liver Failure Consortium(CATCH-LIFE)-MELD score)was developed as follows:0.028×age+0.3×HE grade+0.039×neutrophil count+0.079×MELD score.CATCH-LIFE-MELD score achieved a concordance index of 0.791/0.788 for 28-day/90-day outcomes,which is superior to other traditional scores.Other discrimination indices,including net reclassification improvement,integrated discrimination improvement and probability density function,and calibration including Nagelkerke’s R2 and Brier scores confirmed its superiority.Moreover,the accuracy of CATCH-LIFE-MELD score remained stable.It was highest in patients with or without hepatitis B virus infection,cirrhosis,liver failure or under the Chinese Group on the Study of Severe Hepatitis B(COSSH)criteria or European Association for the Study of the Liver(EASL)criteria.All results were substantiated by an evaluation using an external cohort.Conclusions CATCH-LIFE-MELD score,a modified MELD score exhibited improved accuracy in predicting the short-term prognosis of ACLF than other traditional scores.
文摘目的探讨预后营养指数(PNI)联合MELD评分评估肝硬化失代偿期患者预后的价值。方法纳入2020年1月至2023年1月合肥市第一人民医院确诊的失代偿期肝硬化患者216例,以死亡为终点事件,按照随访1年的转归情况分为生存组156例和死亡组60例,比较两组患者入院时PNI、CTP评分、MELD水平。运用单因素和多因素Cox回归模型预测1年死亡的独立影响因素,以ROC曲线下面积(AUC)评估PNI预测的准确性。按照约登指数计算PNI的最佳临界值,绘制Kaplan-Meier曲线分析不同PNI水平患者的1年生存率。通过二分类变量logistic回归对PNI、MELD评分进行联合预测患者1年死亡的价值。采用限制性立方样条(restricted cubic spline,RCS)拟合Cox回归模型评估不同的PNI截点与1年死亡风险的关系。结果随访1年死亡60例(27.78%),死亡组入院时PNI明显低于生存组[29.0(25.7~31.7)比36.5(30.6~41.0),P<0.001]。PNI与CTP评分、MELD评分呈负相关性(r=-0.766、-0.483,P<0.001)。PNI是患者1年死亡风险的独立影响因素(OR:0.938,95%CI:0.889~0.991,P=0.021);ROC曲线显示PNI及MELD评分预测患者1年死亡风险最佳临界值分别为33.45、16.61,AUC分别为0.780、0.871。而PNI联合MELD评分对患者1年死亡预测效率可提高至0.885(P<0.001)。RCS显示PNI和1年死亡风险呈线性关系(P for nonlinear>0.05)。结论肝硬化失代偿期患者PNI联合MELD评分能够有效预测1年死亡风险。
文摘Background & Objectives: Hepatocellular carcinoma (HCC) leads to high morbidity and mortality. Various models have been proposed for predicting the outcome of patients with HCC. We aim to compare the prognostic abilities of Child-Pugh, MELD, MELD-Na, and ALBI scores for predicting in-hospital mortality of HCC. Methods: We enrolled patients diagnosed with liver cirrhosis and HCC from May 2017 through May 2018. We further divided eligible patients into hepatitis B virus (HBV), patients without ascites, and patients with ascites subgroups. Areas under the characteristic curves (AUCs) were analyzed. Results: A total of 495 patients were included in the study. We collected data on patients at admission. A majority of patients were infected with HBV (91.5%). None of them were complicated with hepatic encephalopathy. Only 14.9% of patients presented with ascites. In the whole population, AUCs with 95% confidence interval (CI) of Child-Pugh, ALBI, MELD, and MELD-Na scores in predicting in-hospital mortality were 0.889 (95% CI: 0.858 - 0.915), 0.849 (95% CI: 0.814 - 0.879), 0.669 (95% CI: 0.626 - 0.711), and 0.721 (95% CI: 0.679 - 0.760), respectively. In the patients without ascites subgroup, Child-Pugh showed better discriminatory ability than ALBI score in predicting in-hospital mortality (P = 0.0002), while there were no significant differences among other comparisons. Conclusions: Child-Pugh and ALBI may be useful predictors for predicting in-hospital mortality in whole patients, in patients with HBV infection, and in patients without ascites. In HCC patients with ascites, MELD-Na may be effective for predicting in-hospital mortality.
