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从GEMA-Na得分中排除炎并不会影响肝移植候选人的结果预测
Manuel Luis Rodríguez-Perálvarez1,2, Antonio Manuel Gómez-Orellana3, Avik Majumdar4,5
1Department of Hepatology and Liver Transplantation, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, Spain.
概括
从德国和欧洲肝病评估模型- (GEMA-Na) 评分中删除瘤仍然允许它超过其他肝脏分配评分. 这种修改后的GEMA-Na得分准确地预测了肝移植候选人的结果,即使瘤评估是主观的.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 移植医学 移植医学
- 医疗信息学 医疗信息学
背景情况:
- 德国和欧洲肝病-评价模型 (GEMA-Na) 评分对肝脏分配有效,但对其炎组件的主观性存在担忧.
- ,肝病的常见并发症,影响患者的预后和移植资格.
研究的目的:
- 为了比较修改的GEMA-Na得分,不包括,与其他肝脏分配得分 (MELD 3.0,MELD-Na) 的性能.
- 评估瘤对肝移植候选人等候名单结果的预后影响.
主要方法:
- 一项跨国队列研究包括来自英国,澳大利亚和西班牙 (2010-2021) 的15,391名成年肝移植候选人.
- 主要结局是90天死亡率或因疾病退出名单.
- 使用多变量考克斯回归评估了炎的预后影响,并通过Harrell的c统计 (Hc) 测量了歧视.
主要成果:
- 炎的存在和严重程度与主要结局的风险增加显著相关 (p < 0.001).
- 没有瘤的GEMA-Na显示了歧视的边际下降 (Hc = 0.753),但仍然明显超过MELD 3.0 (Hc = 0.734) 和MELD-Na (Hc = 0.737).
- 在女性中,GEMA-Na与无炎显示出相似的歧视,两者都表现优于MELD 3.0和MELD-Na.
结论:
- 尽管风具有预后意义,但没有风的GEMA-Na有效地预测了等候名单的结果.
- 修改后的GEMA-Na得分提供了一个可行的替代方案,当被认为对肝脏分配太主观.
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