中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Issue 7
Jul.  2018

Value of MELD score, MELD-Na score, and King's College Hospital criteria in evaluating the prognosis of patients with acute liver failure of pregnancy

DOI: 10.3969/j.issn.1001-5256.2018.07.028
  • Received Date: 2018-01-24
  • Published Date: 2018-07-20
  • Objective To investigate the value of the Model for End-Stage Liver Disease ( MELD) score, MELD combined with serum sodium concentration ( MELD-Na) score, and King's College Hospital ( KCH) criteria in evaluating the prognosis of patients with acute liver failure ( ALF) of pregnancy. Methods A total of 50 patients who were admitted to the Third Affiliated Hospital of Guangzhou Medical University from January 1, 2010 to June 30, 2017 with ALF of pregnancy as the initial diagnosis were enrolled, and according to prognosis, they were divided into death group and survival group. The patients were evaluated using the MELD score, MELD-Na score, and KCH criteria, and the association between these models and prognosis was analyzed. The t-test or Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic ( ROC) curve was plotted; the sensitivity, specificity, positive predictive value, and negative predictive value of each model were calculated; the area under the ROC curve ( AUC) was used to analyze the value of these three models in predicting the prognosis of patients with ALF of pregnancy. Results Of all 50 patients, 14 died and 36 survived, resulting in a mortality rate of 28. 0%. Compared with the survival group on admission, the death group had significant increases in MELD score ( 39. 66 ± 5. 17 vs 29. 63 ± 6. 19, t = 5. 36, P <0. 05) and MELD-Na score ( 43. 89 ± 9. 85 vs 31. 32 ± 7. 29, t = 4. 94, P < 0. 05) . On day 3 after admission, the death group had significantly higher MELD score and MELD-Na score than the survival group ( MELD score: 44. 24 ± 3. 96 vs 28. 74 ± 3. 84, t =-12. 68, P <0. 05; MELD-Na score: 46. 34 ± 5. 14 vs 32. 42 ± 4. 95, t =-8. 82, P < 0. 05) . There was no significant difference in mortality rate between the patients who met the KCH criteria and those who did not ( 8/25 vs 6/25, χ2= 0. 397, P = 0. 754) . The ROC curve analysis showed that baseline MELD score had an AUC of 0. 885 ( 95% confidence interval [CI]: 0. 781-0. 988, P < 0. 01) , a sensitivity of71. 4%, and a specificity of 94. 4%; MELD-Na score had an AUC of 0. 873 ( 95% CI: 0. 764-0. 982, P < 0. 01) , a sensitivity of78. 6%, and a specificity of 88. 9%; KCH criteria had an AUC of 0. 548 ( 95% CI: 0. 392-0. 670, P < 0. 05) , a sensitivity of 57. 1%, and a specificity of 52. 7%. Baseline MELD score and MELD-Na score were divided into groups according to the cut-off value of ROC curve, and the analysis showed that the mortality rate of patients increased with the increases in MELD score and MELD-Na score ( χ2=21. 337 and 17. 294, both P < 0. 001) . Conclusion MELD score, MELD-Na score, and KCH criteria can predict the prognosis of patients with ALF of pregnancy, and MELD score and MELD-Na score have a better clinical value than the KCH criteria.

     

  • [1]CHENG JX, SUN LH, ZHANG YX.Research progress on prognosis evaluation of liver failure[J].Chin J Clin Infect Dis, 2014, 7 (2) :188-192. (in Chinese) 程家喜, 孙丽华, 张跃新.肝衰竭预后评估的研究进展[J].中华临床感染病杂志, 2014, 7 (2) :188-192.
    [2] JASHNANI KD, RUPANI AB, WANI RJ.Maternal mortality:An autopsy audit[J].J Postgrad Med, 2009, 55 (1) :12-16.
    [3] Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, CMA;Severe Liver Diseases and Artificial Liver Group, Chinese Society of Hepatology, CMA.Guideline for diagnosis and treatment of liver failure (2012 version) [J].Chin J Clin Infect Dis, 2012, 5 (6) :321-327. (in Chinese) 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南 (2012年版) [J].中华临床感染病杂志, 2012, 5 (6) :321-327.
    [4]KAMATH PS, WIESNER RH, MALINCHOC M, et al.A model to predict survival in patients with end-stage liver disease[J].Hepatology, 2001, 33 (2) :464-470.
    [5]BIGGINS SW, KIM WR, TERRAULT NA, et al.Evidence-based incorporation of serum sodium concentration into MELD[J].Gastroenterology, 2006, 130 (6) :1652-1660.
    [6] O'GRADY JG, ALEXANDER GJ, HAYLLAR KM, et al.Early indicators of prognosis in fulminant hepatic failure[J].Gastroenterology, 1989, 97 (2) :439-445.
    [7] USTA IM, BARTON JR, AMON EA, et al.Acute fatty liver of pregnancy:An experience in the diagnosis and management of fourteen cases[J].Am J Obstet Gynecol, 1994, 171 (5) :1342-1347.
    [8] SIBAI BM, RAMADAN MK, USTA I, et al.Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome) [J].Am J Obstet Gynecol, 1993, 169 (4) :1000-1006.
    [9] ROBERTS JM, REDMAN CW.Pre-eclampsia:More than pregnancy-induced hypertension[J].Lancet, 1993, 341 (8858) :1447-1451.
    [10]XIONG HF, LIU JY, GUO LM, et al.Acute fatty liver of pregnancy:Over six months follow-up study of twenty-five patients[J].World J Gastroenterol, 2015, 21 (6) :1927-1931.
    [11]KOO JK, KIM JH, CHOI YJ, et al.Predictive value of Refit Model for End-Stage Liver Disease, Refit Model for End-Stage Liver Disease-Na, and pre-existing scoring system for 3-month mortality in Korean patients with cirrhosis[J].J Gastroenterol Hepatol, 2013, 28 (7) :1209-1216.
    [12] DHIMAN RK, JAIN S, MAHESHWARI U, et al.Early indicators of prognosis in fulminant hepatic failure:An assessment of the Model for End-Stage Liver Disease (MELD) and King's College Hospital criteria[J].Liver Transpl, 2007, 13 (6) :814-821.
    [13]SHI XX, ZHANG YQ, ZHU P, et al.Prognostic risk factors in patients with hepatitis B virus-related acute-on-chronic liver failure[J].J Clin Hepatol, 2016, 32 (4) :700-705. (in Chinese) 石新星, 张艳琼, 朱鹏, 等.乙型肝炎相关慢加急性肝衰竭患者预后的危险因素分析[J].临床肝胆病杂志, 2016, 32 (4) :700-705.
    [14]Mc PHAIL MJ, FARNE H, SENVAR N, et al.Ability of King's College Criteria and Model for End-Stage Liver Disease Scores to predict mortality of patients with acute liver failure:A meta-analysis[J].Clin Gastroenterol Hepatol, 2016, 14 (4) :516-525.
    [15]CHOLONGITAS E, THEOCHARIDOU E, VASIANOPOULOU P, et al.Comparison of the sequential organ failure assessment score with the King's College Hospital criteria and the model for end-stage liver disease score for the prognosis of acetaminophen-induced acute liver failure[J].Liver Transpl, 2012, 18 (4) :405-412.
    [16]DENG LZ, LI XM, CHEN DJ, et al.Then effect of MELD scoring system for predicting the short-term prognosis of pregnancy complicating fulminant hepatitis[J].Chin J Prac Gynecol Obstetr, 2010, 26 (3) :209-212. (in Chinese) 邓柳枝, 李小毛, 陈敦金, 等.终末期肝病模型评分对妊娠合并重型肝炎短期预后的评价作用[J].中国实用妇科与产科杂志, 2010, 26 (3) :209-212.
    [17]MURALI AR, DEVARBHAVI H, VENKATACHALA PR, et al.Factors that predict 1-month mortality in patients with pregnancy-specific liver disease[J].Clin Gastroenterol Hepatol, 2014, 12 (1) :109-113.
    [18]WESTBROOK RH, YEOMAN AD, O'GRADY JG, et al.Model for end-stage liver disease score predicts outcome in cirrhotic patients during pregnancy[J].Clin Gastroenterol Hepatol, 2011, 9 (8) :694-699.
    [19]von DADELSZEN P, PAYNE B, LI J, et al.Prediction of adverse maternal outcomes in pre-eclampsia:Development and validation of the full PIERS model[J].Lancet, 2011, 377 (9761) :219-227.
    [20] LI C, YOU SL, LIU HL, et al.The value of the baseline MELD scores, MELD-Na scores and i MELD scores in short-tern prognosis in hepatitis B virus related acute-on-chronic liver failure patients[J].Chin Crit Care Med, 2014, 26 (8) :539-543. (in Chinese) 李晨, 游绍莉, 刘鸿凌, 等.基线MELD、MELD-Na、i MELD 3种模型对乙型肝炎病毒相关慢加急性肝衰竭患者近期预后的评估价值[J].中华危重病急救医学, 2014, 26 (8) :539-543.
    [21]LI XS, LYU HM, LI FH, et al.Values of MELD, MELD-Na and SOFA scores for prediction of liver failure[J].Tianjin Med J, 2012, 40 (9) :902-904. (in Chinese) 李晓爽, 吕洪敏, 李凤惠, 等.MELD、MELD-Na、SOFA评分系统对肝衰竭短期预后的价值[J].天津医药, 2012, 40 (9) :902-904.
    [22]FENG HL, LI Q, WANG L, et al.Indocyanine green clearance test combined with MELD score in predicting the short-term prognosis of patients with acute liver failure[J].Hepatobiliary Pancreat Dis Int, 2014, 13 (3) :271-275.
    [23]DU WB, PAN XP, LI LJ.Prognostic models for acute liver failure[J].Hepatobiliary Pancreat Dis Int, 2010, 9 (2) :122-128.
    [24] SHIN HS, KIM SP, HAN SH, et al.Prognostic indicators for acute liver failure development and mortality in patients with hepatitis A:Consecutive case analysis[J].Yonsei Med J, 2014, 55 (4) :953-959.
  • Relative Articles

    [1]Yunchong WU, Yanyan YANG, Chuan LI, Xiaohuan WU, Shide LIN. Role of inflammatory cytokines in disorder of glucose metabolism in patients with liver cirrhosis[J]. Journal of Clinical Hepatology, 2024, 40(9): 1886-1890. doi: 10.12449/JCH240926
    [2]Yifan YANG, Wanwei DU, Xia WANG, Guangde YANG, Li LI, Juanjuan FU, Xiucheng PAN. Effect of the STING pathway on inflammatory cytokine secretion and phagocytosis by peripheral blood monocytes in patients with hepatitis B cirrhosis[J]. Journal of Clinical Hepatology, 2023, 39(9): 2117-2121. doi: 10.3969/j.issn.1001-5256.2023.09.013
    [3]Hepatology|Macrophage-specific fibroblast growth factor 12 promotes liver fibrosis progression in mice[J]. Journal of Clinical Hepatology, 2022, 38(8): 1885-1885. doi: 10.3969/j.issn.1001-5256.2022.08.gwjpwzjj2
    [4]Zixiang GAO, Zhongliang SHEN, Jing LIU, Youhua XIE. Research advances in cytokines in the treatment of chronic hepatitis B[J]. Journal of Clinical Hepatology, 2022, 38(8): 1710-1715. doi: 10.3969/j.issn.1001-5256.2022.08.002
    [5]Xiaofei YANG, Linxu WANG, Changxing HUANG, Jie DONG, Haifeng HU, Zhanhu BI, Jianqi LIAN, Ye ZHANG. Mechanism of gamma-chain cytokines in regulating the expression of T-cell immunoglobulin and mucin domain-containing molecule 3 in CD8+ T cells of chronic hepatitis B patients[J]. Journal of Clinical Hepatology, 2021, 37(5): 1059-1064. doi: 10.3969/j.issn.1001-5256.2021.05.017
    [6]Leigang JIN, Leiluo GENG, Aimin XU. Current status and perspectives of fibroblast growth factor 21 in nonalcoholic fatty liver disease[J]. Journal of Clinical Hepatology, 2021, 37(6): 1262-1267. doi: 10.3969/j.issn.1001-5256.2021.06.006
    [7]Zhang Yu, Shao YueMing, Qin TingTing, Yin Xin, Wen XiaoYu. Current research status and application value of cytokines in drug-induced liver injury[J]. Journal of Clinical Hepatology, 2020, 36(8): 1883-1886. doi: 10.3969/j.issn.1001-5256.2020.08.045
    [8]Gao Yi, Liang ZhiJun, Fu Jian. Influence of sofosbuvir-based antiviral therapy on the expression profile of cytokines and chemokines in patients with chronic hepatitis C[J]. Journal of Clinical Hepatology, 2019, 35(10): 2200-2204. doi: 10.3969/j.issn.1001-5256.2019.10.014
    [9]Wei XinHuan, Liu YaLi, Zhang Jing, Lin Wei. Expression and significance of cytokines in children with acute hepatitis A[J]. Journal of Clinical Hepatology, 2019, 35(9): 1942-1945. doi: 10.3969/j.issn.1001-5256.2019.09.011
    [10]Xiang Jiao, Jia XiaoDong, Lu ShanShan, Wu DaWei, Zhang Ting, Dong JinKe, Huang JiaGan, Li YinYin, Yang Bin, Xu Yong, Dong Zheng, Lu Ying, Zeng Zhen, Lu YinYing. Effect of cryoablation versus microwave ablation on clinical indices and cytokines in patients with hepatocellular carcinoma[J]. Journal of Clinical Hepatology, 2019, 35(8): 1728-1733. doi: 10.3969/j.issn.1001-5256.2019.08.016
    [11]Sheng QingShou, Lai GuoQuan, Yu XueJing, Wei Cui. The role of traditional Chinese medicine in regulating cytokines associated with liver fibrosis[J]. Journal of Clinical Hepatology, 2018, 34(12): 2677-2680. doi: 10.3969/j.issn.1001-5256.2018.12.037
    [12]Li ShuHuan, Han JiWu. Inhibitory effect of fibroblast growth factor-21 on the carcinogenesis of L02 cells induced by diethylnitrosamine[J]. Journal of Clinical Hepatology, 2018, 34(2): 321-326. doi: 10.3969/j.issn.1001-5256.2018.02.020
    [13]Guo FeiBo, Wu JunZhu, Ai LiMing, Song Ying. Clinical significance of Th17/Treg and associated cytokines in peripheral blood in chronic hepatitis C patients with liver cirrhosis[J]. Journal of Clinical Hepatology, 2017, 33(3): 479-484. doi: 10.3969/j.issn.1001-5256.2017.03.017
    [14]Zhang Ning, Guo ZhenZhong, Cheng Yan. Effect of dexmedetomidine on liver function, cytokine levels, and oxidative stress in patients undergoing hepatolobectomy[J]. Journal of Clinical Hepatology, 2017, 33(3): 507-511. doi: 10.3969/j.issn.1001-5256.2017.03.022
    [16]Shi GuangYing, Ma XiaoYuan, Xie JingDong. Changes in T lymphocyte subsets and cytokines in peripheral blood of patients with primary biliary cirrhosis after treatment with different doses of ursodeoxycholic acid[J]. Journal of Clinical Hepatology, 2015, 31(9): 1447-1451. doi: 10.3969/j.issn.1001-5256.2015.09.020
    [17]Wang ShaoYang, Lin TaoFa, Liu HaiZhou, Ma WeiMin, Xie ZhiHong. A clinical study of autologous cytokine-induced killer cells in treatment of patients with chronic hepatitis B[J]. Journal of Clinical Hepatology, 2015, 31(4): 530-533. doi: 10.3969/j.issn.1001-5256.2015.04.013
    [18]Zhang LiangJie, Chen HuiJuan, Zhao ShouSong. Effects of artificial liver plasma exchange on cytokines in patients with liver failure[J]. Journal of Clinical Hepatology, 2015, 31(4): 578-581. doi: 10.3969/j.issn.1001-5256.2015.04.024
    [19]Chen WeiHong, Chen Yan. Serum Th1 /Th2 cytokine levels and their clinical significance in patients with alcoholic liver cirrhosis[J]. Journal of Clinical Hepatology, 2014, 30(7): 631-635. doi: 10.3969/j.issn.1001-5256.2014.07.014
    [20]Zhou Jian, Wan Hong. Relationship between changes in serum cytokine levels after artificial liver therapy and clinical prognosis in patients with liver failure[J]. Journal of Clinical Hepatology, 2013, 29(7): 535-537. doi: 1001-5256 (2013) 07-0535-03
  • Cited by

    Periodical cited type(3)

    1. 张艳培,梁健,邓鑫,梁明坤,张冰冰,徐粤娟. 浅析肝纤维化发生机制. 大众科技. 2021(02): 41-44+12 .
    2. 曾静,熊庆,张丽丽,袁娟,何莹,邱黎菲. SPACE肽修饰成纤维细胞生长因子21的制备及对小鼠皮肤瘢痕形成的抑制作用. 中国免疫学杂志. 2021(11): 1308-1312 .
    3. 唐青蓝,李红梅,张礼林,王玉丰,颜礼完,周君. 小鼠FGF21基因克隆及his-mFGF21融合蛋白的诱导表达. 贵州医科大学学报. 2019(05): 552-556 .

    Other cited types(0)

  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Article Metrics

    Article views (2089) PDF downloads(361) Cited by(3)
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return