课件：终末期肝病的肝功能评估.ppt

THANK YOU SUCCESS * * 可编辑 MELD-Na MELD-Na = MELD +1.0x(140- Na) ? 0.025 × MELD ×(140 ? Na) . Use of the MEL-DNa score may reduce mortality among patients on the waiting list. The difference between the MELD score and the MELD-Na score was often large enough to make a real difference in the probability of receiving a liver transplant and averting death W.Ray Kim et al.N Eng J Med 2008;359:1018-26 W.Ray Kim et al.N Eng J Med 2008;359:1018-26 the expected number of transplantations : 67 × (58.4% ? 18.5%)+ 43 × (70.4% ? 58.4%)=32 Thus, 7% of deaths (32 of 477) that occurred within 3 months after registration on the waiting list might have been prevented Prevalence of Ascites, Severity of Liver Failure, Renal Function, and Mortality According to HyponatremiaStatus in Patients Not Transplanted Within 3 Months No hyponatremia Hyponatremia? Value (n=160) (n=34) p Serum sodium (mEq/L) 138 ± 3 127 ± 4 0.001 Clinical ascites 66 (41%) 34 (100%) 0.001 Total bilirbin (mg/dL) 5.3 ± 5.9 11.1 ± 9.1 0.001 INR 1.5 ± 0.5 1.9 ± 1.1 0.001 MELD score 15.4 ± 5.2 21.1 ± 7.9 0.001 Serum creatinine (mg/dL) 0.8 ± 0.3 0.8 ± 0.4 0.28 Elevated serum creatinine 5 (3%) 3 (9%) 0.14 3-month mortality 7 (4%) 12 (35%) 0.001 ? Hyponatremia was defined as serum sodium ≤ 130 mEq/L Liver Transplantation,Vol 11,No3 ,2005: pp336-343 iMELD iMELD score=MELD + (0.3×年龄) - (0.7×血清钠) + 100 [Liver T