论文部分内容阅读
Background Serum sodium predicts prognosis in chronic severe hepatitis B and may improve the prognostic accuracy of the model for end-stage liver disease (MELD) score, but the available information is limited. The present study was undertaken to study the clinical use of the serum sodium incorporated MELD (MELD-Na) and assess its validity by the concordance (c)-statistics in predicting the prognosis of the patient with chronic severe hepatitis B. Methods A total of 426 adult patients with a diagnosis of chronic severe hepatitis B between January 1, 2007, and December 31, 2007 at a single center were studied. The scores of serum sodium, MELD, MELD-Na, and △MELD-Na (△MELD-Na=MELD-Na at 14 days after medical treatment -MELD-Na score on admission) of the patients with chronic severe hepatitis B were calculated. The 3-month mortality in the patients was measured, and the validity of the models was determined by means of the concordance (c) statistics.Results The average MELD, MELD-Na scores of survival group were 25.70±5.08 and 26.60±6.90.and those of dead group were 35.60±6.78 and 42.80±9.57 on admission.There was a significant difference in MELD and MELD-Na between the survivaI and dead groups(P<0.01).The average △MELD-Na SCOre of the survivaI group was-0.97±3.51,and that of the dead group was 3.45±2.38 at 2 weeks after the treatment.There was a significant difference in△MELD-Na between the survivaI and dead groups(P<0.01).The areas under the receiver-operating characteristic curves of Na,MELD and MELD-Na for the occurrence of death in 3 months were 0.742.0.875 and 0.922.The 3-menth mortality of the MELD-Na scores group<25,25-30,31.31-34,35-40 and>40 were 2.O%,5.4%,35.4%,53.8%and 86.9%,respectively.There was a significant difference in the 3-ionth mortality between the five groups(P<0.05).The 3-month mortality of the △MELD-Na>0 group Was 65.9%.and that of the △MELD-Na≤0 group Was 15.8%;there Was a significant difference in the 3-month mortality between the twogroups(P<0.05).Conclusions MELD-Na score is a valid model to predict the 3-month mortality in paUents with chronic severe hepatitis B.△MELD-Na is a clinically useful parameter for predicting the therapeutic effect of chronic severe hepatitisB.