Analysis of prognosis on patients with severe viral hepatitis using the model for end-stage liver disease.
OBJECTIVE
To study the practical use of the model for end-stage liver disease (MELD) on clinic and assess its validity by the concordance (C)-statistic in predicting the prognosis of the patient with severe viral hepatitis.


METHODS
One hundred and twenty-one patients were divided into plasma exchange group and non-plasma exchange group, and were graded with MELD formula. The death rate was observed within 3 mo.


RESULTS
Eighty-one patients died within 3 mo (35 cases in PE group, 46 cases in non-PE group). The mortality of patients in PE group whose MELD score between 20-30 and 30-40 were 31.6% and 57.7%, respectively, but in non-PE cases they were 67.6%, 81.3% respectively. There was significant difference between PE group and non-PE group (P<0.05). However, the mortality of patients whose MELD score higher than 40 were 93.3% in PE group and 100% in non-PE group and there was no significant difference between the two groups (P = 0.65>0.05). The optimal cut-off values of MELD to predict the prognosis of patients were 30 in PE group whose sensitivity, specificity and C-statistic were 80.0%, 52.0% and 0.777, but in non-PE group they were 25, 82.6%, 86.7% and 0.869, respectively.


CONCLUSIONS
The MELD score can act as a disease severity index for patients with severe viral hepatitis, and the mortality of the patient increases with the increase of the MELD score. The MELD can accurately predict the short-term prognosis of patients with severe viral hepatitis.
Weng
Zhi-Hong
ZH
Department of Infectious Diseases, Xiehe Hospital, Tongji Medical College, Huazhong Science and Technology University, Wuhan 430022, Hubei Province, China. wengzh2004@yahoo.com.cn
Cai
Shu-Qing
SQ
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006525:Hepatitis, Viral, Human / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index