中山大学学报（医学科学版）2025，Vol.46Issue(2)：318-327,10.
以MELD 3.0为基础的模型在预测酒精性肝硬化患者生存预后中的价值
Prognostic Value of MELD 3.0 Based Model for Survival Outcomes in Alcoholic Cirrhosis Patients
摘要
Abstract
[Objective]To explore the value of the Model for End-Stage Liver Disease(MELD)3.0 in predicting survival outcomes for patients with alcoholic cirrhosis and to establish an effective mortality prediction model.[Methods]Clinical data of 788 hospitalized patients who were first diagnosed with alcoholic cirrhosis at the Third Affiliated Hospital of Sun Yat-sen University between January 1,2011 and December 31,2019 were analyzed.Patients were followed up until December 31,2023 and divided into survival and mortality groups based on the survival outcomes at 30 days,90 days,1 year,and 3 years after admission.The prognostic values of the MELD 3.0,MELD,MELD-Sodium(MELD-Na)for survival in alcoholic cirrhosis patients were assessed and compared by using the receiver operating characteristic(ROC)curve and the area under the curve(AUC).Additional risk factors associated with mortality in alcoholic cirrhosis patients were identified,and a novel mortality prediction model based on MELD 3.0 was developed.[Results]The AUC of the MELD 3.0 score in predicting 30-day,90-day,1-year,and 3-year survival was 0.823,0.730,0.686,and 0.658,respectively,which were superior to those of the MELD-Na(0.802,0.708,0.666,and 0.645,respectively)and MELD scores(0.698,0.668,0.654,and 0.633,respectively)(all P<0.05).MELD 3.0 demonstrated better performance at 30 and 90 days(AVC=0.823,0.730;both P<0.05)than at 1 year and 3 years(AVC=0.686,0.658;both P<0.05).Binary logistic regression combined with LASSO regression indicated that the independent risk factors associated with the 1-year outcome included MELD 3.0,baseline ascites and hepatocellular carcinoma.A survival prediction model was then established with AUC of 0.748,sensitivity of 0.695,and specificity of 0.775.[Conclusions]MELD 3.0 has a superior predictive ability for 30-day,90-day,1-year,and 3-year survival in patients with alcoholic cirrhosis than MELD-Na and MELD.The prediction model incorporating MELD 3.0,ascites and hepatocellular carcinoma improves the prediction of 1-year survival outcomes for alcoholic cirrhosis patients.关键词
酒精性肝病/预后/MELD3.0/MELD/MELD-NaKey words
alcoholic liver disease/prognosis/end-stage liver disease(MELD)3.0/MELD/MELD-sodium(MELD-Na)分类
医药卫生引用本文复制引用
钟臻蔚,Kodjo Kunale ABASSA,陈荣,郭云蔚,吴斌..以MELD 3.0为基础的模型在预测酒精性肝硬化患者生存预后中的价值[J].中山大学学报（医学科学版）,2025,46(2):318-327,10.基金项目
国家自然科学基金(82370599) （82370599）
