Title:Meld score and serum sodium in the prediction of survival of patients with cirrhosis awaiting liver transplantation.
标题：MELD评分和血清钠水平对等待肝移植肝硬化病人的生存预测
Author: Londono MC, Cardenas A, Guevara M, de Las Heras D, Navasa M, Rimola A, Garcia-Valdecasas JC, Arroyo V, Gines P.
作者：Londono MC, Cardenas A, Guevara M, de Las Heras D, Navasa M, Rimola A, Garcia-Valdecasas JC, Arroyo V, Gines P.
Source:Gut. 2007 Apr 23;
来源：Gut. 2007 Apr 23;
IF:7.692(2005)
影响因子：7.692(2005)
Background/ AIMS: Serum sodium predicts prognosis in cirrhosis and may improve the prognostic accuracy of MELD score, but the available information is limited. We aimed to assess the prognostic value of serum sodium in the prediction of survival at 3 and 12 months after listing in patients with cirrhosis awaiting liver transplantation and compare its predictive value with that of MELD score.
背景和目的：血清钠水平能预测肝硬化预后，或许还能增加MELD评分的预测准确性，但现有的资料有限。我们的目的在于评估血清钠在肝硬化病人等待肝移植3和12个月后生存预测的预后判断价值，并将其预测值同MELD评分进行比较。
PATIENTS AND METHODS: Three-hundred and eight consecutive patients with cirrhosis listed for transplantation during a 5-year period were included in the study. End-point was survival at 3 and 12 months before transplantation. Variables obtained at the time of listing were analyzed for prognostic value using multivariable analysis. Accuracy of prognostic variables was analyzed by ROC curves.
病人属性和方法：该研究收录了5年内连续308名等待移植的肝硬化病人。研究点为移植前3和12个月的存活率。等待期间获取的变量资料以多变量分析的方法判断其预测价值。预后变量的准确性则经过ROC曲线分析。
RESULTS: MELD score and serum sodium concentration were the only independent predictors of survival at 3 and 12 months after listing. Low serum sodium was associated with an increased risk of death in all subpopulations of patients with cirrhosis categorized according to the major complication developed before listing. The area under the ROC curves for serum sodium and MELD score was not significantly different both at 3 months (0.83 vs. 0.79, respectively) and at 12 months (0.70 vs. 0.77, respectively). The addition of serum sodium did not improve significantly the accuracy of MELD score in the prediction of survival at 3 and 12 months.
结果：MELD评分和血清钠水平是等待3和12个月后仅有的独立生存预测因子。低血清钠水平与等待移植前根据主要并发症而分类的所有肝硬化病人亚群的高死亡风险有关。血清钠和MELD评分在第3和第12个月ROC曲线下面积没有显著差别（3个月分别为0.83和0.89，12个月分别为0.70和0.77）。附加的血清钠水平并不能显著增加MELD评分在第3和第12个月生存预测的准确性。
CONCLUSION: In patients with cirrhosis awaiting liver transplantation, serum sodium and MELD were found to be independent predictors of survival. Larger studies are needed to determine whether the addition of serum sodium to MELD can improve its prognostic accuracy.
结论：对等待肝移植的病人而言，血清钠水平和MELD评分都是独立的生存预测因子。但尚需更大规模的研究来确定结合血清钠水平后是否能增加MELD评分的预测准确性。
编译：
血清钠水平不能增加MELD评分对等待肝移植肝硬化病人生存预测的准确性
Londono MC等人最近的研究表明，血清钠水平不能增加MELD评分对等待肝移植肝硬化病人生存预测的准确性。（Gut. 2007 Apr 23;2005年影响因子7.692）
血清钠水平能预测肝硬化预后，但现有的资料尚不能证明血清钠水平能增加MELD评分对等待肝移植肝硬化病人存活率的预测准确性。Londono MC等对5年内连续308名等待移植的肝硬化病人在移植前3和12个月的存活率进行研究后认为，血清钠水平和是MELD评分都是等待移植3和12个月后仅有的独立生存预测因子，且两者ROC曲线下面积没有显著差别（3个月分别为0.83和0.89，12个月分别为0.70和0.77），血清钠水平并不能显著增加MELD评分在第3和第12个月生存预测的准确性。因此，Londono MC等认为还需要更大规模的研究来确定结合血清钠水平后是否能增加MELD评分的预测准确性。
