Background and Aims:Since the adoption of novel prognostic scores,such as the iterative model for end-stage liver disease(MELD 3.0)and the gender-equity model for liver allocation(GEMA),their utility has markedly expa...Background and Aims:Since the adoption of novel prognostic scores,such as the iterative model for end-stage liver disease(MELD 3.0)and the gender-equity model for liver allocation(GEMA),their utility has markedly expanded to diverse clinical scenarios.However,data concerning their prognostic value in more generalized cirrhotic populations are scarce.In this study,we aimed to elucidate the MELD 3.0/GEMA-Na for long-term mortality risk stratification and refine their usage scope.Methods:This study retrospectively reviewed 310 hospitalized patients with decompensated cirrhosis.Discrimination and stratification were compared between MELD 3.0/GEMA-Na and other scores.Validation was performed in another 120 subjects.Results:In the investigated cohort,the median MELD-Na,MELD 3.0,and GEMA-Na were 9(7,12),12(10,17),and 12(9,17),respectively.Compared to their predecessors,both MELD 3.0 and GEMANa models exhibited consistently better discriminative ability,especially in relation to long-term mortality.This effect was more pronounced for GEMA-Na,which was the only score to present an area under the receiver operating characteristic curve greater than 0.8 up to two years(0.807).Statistical analysis indicated that a MELD 3.0 score of 18 and a GEMANa score of 20 were the most optimal cutoffs to rank the risk of death,both of which were independently associated with two-year all-cause transplant-free mortality(MELD 3.0:hazard ratio:1.13,95%confidence interval:1.10,1.17;GEMANa:hazard ratio:1.12,95%confidence interval:1.10,1.17,both P<0.001).Similar findings were affirmed in the validation cohort.Conclusions:MELD 3.0 is superior to other MELD-based scores for long-term prognostication in hospitalized patients with cirrhosis,while GEMA-Na demonstrated even better accuracy and performance.展开更多
Since its proposal,the Model for End-Stage Liver Disease(MELD)score has been employed to predict short-term mortality among patients with chronic liver disease and those awaiting liver transplantation,serving as the p...Since its proposal,the Model for End-Stage Liver Disease(MELD)score has been employed to predict short-term mortality among patients with chronic liver disease and those awaiting liver transplantation,serving as the primary criterion for organ allocation.However,as the demographic and epidemiological characteristics of chronic liver disease and liver transplantation have evolved,a range of MELDrelated scores has emerged,including MELD-Na,iMELD,delta MELD,MELD XI,MELD-LA,and pediatric end-stage liver disease,culminating in the recently proposed MELD 3.0,which builds upon MELD-Na.This study aimed to comprehensively review and summarize relevant studies on MELD 3.0 in various scenarios,assessing its effectiveness in organ allocation,post-transplantation outcomes,and mortality prediction for patients with end-stage liver disease.Our preliminary findings indicate superior predictive performance of MELD 3.0,warranting further in-depth investigations to broaden its clinical implications.展开更多
文摘Background and Aims:Since the adoption of novel prognostic scores,such as the iterative model for end-stage liver disease(MELD 3.0)and the gender-equity model for liver allocation(GEMA),their utility has markedly expanded to diverse clinical scenarios.However,data concerning their prognostic value in more generalized cirrhotic populations are scarce.In this study,we aimed to elucidate the MELD 3.0/GEMA-Na for long-term mortality risk stratification and refine their usage scope.Methods:This study retrospectively reviewed 310 hospitalized patients with decompensated cirrhosis.Discrimination and stratification were compared between MELD 3.0/GEMA-Na and other scores.Validation was performed in another 120 subjects.Results:In the investigated cohort,the median MELD-Na,MELD 3.0,and GEMA-Na were 9(7,12),12(10,17),and 12(9,17),respectively.Compared to their predecessors,both MELD 3.0 and GEMANa models exhibited consistently better discriminative ability,especially in relation to long-term mortality.This effect was more pronounced for GEMA-Na,which was the only score to present an area under the receiver operating characteristic curve greater than 0.8 up to two years(0.807).Statistical analysis indicated that a MELD 3.0 score of 18 and a GEMANa score of 20 were the most optimal cutoffs to rank the risk of death,both of which were independently associated with two-year all-cause transplant-free mortality(MELD 3.0:hazard ratio:1.13,95%confidence interval:1.10,1.17;GEMANa:hazard ratio:1.12,95%confidence interval:1.10,1.17,both P<0.001).Similar findings were affirmed in the validation cohort.Conclusions:MELD 3.0 is superior to other MELD-based scores for long-term prognostication in hospitalized patients with cirrhosis,while GEMA-Na demonstrated even better accuracy and performance.
文摘Since its proposal,the Model for End-Stage Liver Disease(MELD)score has been employed to predict short-term mortality among patients with chronic liver disease and those awaiting liver transplantation,serving as the primary criterion for organ allocation.However,as the demographic and epidemiological characteristics of chronic liver disease and liver transplantation have evolved,a range of MELDrelated scores has emerged,including MELD-Na,iMELD,delta MELD,MELD XI,MELD-LA,and pediatric end-stage liver disease,culminating in the recently proposed MELD 3.0,which builds upon MELD-Na.This study aimed to comprehensively review and summarize relevant studies on MELD 3.0 in various scenarios,assessing its effectiveness in organ allocation,post-transplantation outcomes,and mortality prediction for patients with end-stage liver disease.Our preliminary findings indicate superior predictive performance of MELD 3.0,warranting further in-depth investigations to broaden its clinical implications.
