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[Analysis of short-term prognosis on patients with chronic severe hepatitis B using the model for end-stage liver disease].

OBJECTIVE
To study the practical clinical use of the model for end-stage liver disease (MELD) and assess its validity in predicting the short-term (3 mouths) prognosis of patients with chronic severe hepatitis B. The optimal cut-off values of MELD to discriminate between deceased and surviving patients were calculated by using receiver operator characteristic (ROC) curve.


METHODS
The clinical information of 139 patients with chronic severe hepatitis B was collected. The patients were divided into two groups, including cirrhosis group and non-cirrhosis group (chronic hepatitis group). All the patients were evaluated with MELD. The death rate was recorded within 3 months.


RESULTS
(1)The scores of MELD in all patients were higher than 20 points. The value of MELD between chronic hepatitis group [(31.34+/-7.00) scores, n=72] and cirrhosis group [(31.97+/-6.82) scores, n=67] had no significant difference(P>0.05). The mortality between the two groups had no significant difference, too. (2)The mortality within 3 months was 58.3% (81/139 cases). The mortality of the patients whose MELD score were 20-30 points, 30-40 points and higher than 40 points were 35.6% (26/73 cases), 76.6% (36/47 cases) and 100% (19/19 cases), respectively. Comparing with the higher scores the mortality was increased at the same MELD score. There were no significant difference in mortality between chronic severe hepatitis B and cirrhosis severe hepatitis B (all P>0.05). The optimal cut-off value of MELD score to predict the prognosis of patients was 31, with sensitivity and specificity were 64.2% and 91.4%, respectively, and c-statistic was 0.809 (95% CI 0.738-0.879).


CONCLUSION
The onset of chronic liver failure based on cirrhosis might have no important effect on the short-term prognosis. The MELD score can serve as an index of the severity of patients with chronic severe hepatitis B, and it can be used to predict accurately the short-term prognosis.