Objective To investigate the predictive values of four scoring systems,the Model for End-Stage Liver Disease( MELD),the MELD with incorporation of serum sodium( MELD-Na),the integrated MELD( i MELD),and the MELD to serum sodium ratio( MESO),in the short-term prognosis of patients with hepatitis B-associated acute-on-chronic liver failure( ACLF) after artificial liver support therapy. Methods A total of 221 patients with hepatitis B-associated ACLF who were hospitalized from October 2007 to February 2013 were enrolled as subjects and divided into survival group( n = 139) and death group( n = 82). The levels of total bilirubin( TBil),serum creatinine( Cr),international normalized ratio( INR),serum sodium( Na+),and the scores of MELD,MELD-Na,i MELD,and MESO were determined and compared between the two groups. Comparison of continuous data between two groups was made by the Mann-Whitney U test or t test; comparison between multiple groups was made by the Kruskal-Wallis H test; comparison of categorical data was made by χ2test; comparison of area under the receiver operating characteristic curve was made by normal Z test. Results The age,TBil level,INR,and the scores of MELD,MELD-Na,i MELD,and MESO were significantly higher in the death group than in the survival group,while the serum level of Na+was significantly lower in the death group than in the survival group( P < 0. 001). Patients with end-stage liver failure had significantly higher scores than those with early-stage or intermediate-stage liver failure( P < 0. 001),while patients with intermediate-stage liver failure had significantly higher scores than those with early-stage liver failure( P < 0. 001). The mortality rate increased with increasing scores of MELD,MELD-Na,i MELD,and MESO. The optimal cut-off scores of MELD,MELD-Na,i MELD,and MESO were 37. 989,41. 291,55. 406,and 2. 693,respectively. There were no significant differences between any two scoring systems( P > 0. 05). Conclusion All four scoring systems can well predict the short-term clinical prognosis in patients with hepatitis B-associated ACLF after artificial liver support therapy combined with comprehensive medical treatment. The i MELD scoring system is slightly superior to the other three scoring systems.However,the application of these scoring systems still needs to be closely associated with actual clinical situations.
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