预测准确性对比的预后评分系统的生存在患者接受TIPS安置:一个系统的审查和元分析
Yan Zhao1, Yun Wang1, Junwang Xu1
1Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Academic radiology
|November 24, 2023
概括
末期肝病模型 (MELD) 评分最好预测经过横内肝移植系统 (TIPS) 的短期存活率. 对于长期生存,MELD-Sodium (MELD-Na) 和弗赖堡TIPS后生存指数 (FIPS) 显示出有希望的结果.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 医学统计 医学统计
- 手术结果研究研究.
背景情况:
- 跨内肝移植系统静脉切除术 (TIPS) 是治疗肝门高血压的一个关键程序.
- 准确的风险评估模型 (RAM) 对于预测TIPS后患者存活率至关重要.
- 存在各种RAM,但它们在TIPS后生存预测的比较性能需要彻底评估.
研究的目的:
- 系统地评估和比较不同RAM在预测患有肝门性高血压的患者在TIPS后的存活率方面的表现.
- 为了确定短期 (一年内) 和长期 (一年以上) 存活预测中最有效的RAM.
主要方法:
- 进行了全面的元分析,系统地搜索主要数据库 (PubMed,WOS,Embase,Cochrane,CNKI) 到2023年2月.
- 从使用包括Child-Turcotte-Pugh,MELD,MELD-Na,FIPS,比利鲁宾血小板,CLF-ACD和AGB在内的流行RAM的研究数据进行了汇总.
- 使用接收器操作特征 (AUC) 曲线下的面积来评估RAM在六个时间间隔中的死亡率预测能力,并对效应大小进行了强大的差异估计.
主要成果:
- 末期肝病模型 (MELD) 评分表现出强大的短期预测能力,特别是在1个月 (AUC:0.72) 和3个月 (AUC:0.72) 时.
- MELD-Sodium (MELD-Na) 显示出最佳的长期预测性能,AUC在3.5年时为0.70.
- 弗赖堡TIPS后生存指数 (FIPS) 在6个月生存 (AUC:0.68) 和整体无移植生存 (AUC:0.75) 方面表现良好.
结论:
- 在TIPS之后,MELD评分是短期生存的最有效预测指标.
- FIPS和MELD-Na是预测TIPS后的长期结果的有希望的模型.
- 优化RAM选择对于改善TIPS后患者的治疗结果至关重要,因此需要进一步研究以完善风险分层.
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