Discriminability of acute physiology and chronic health evaluation Ⅳ and model for end-stage liver disease scores on mortality after liver transplantation

doi:10.3877/cma.j.issn.2095-3232.2013.05.010

Abstract

Abstract:

Objective

To explore the discriminability of acute physiology and chronic health evaluation (APACHE) Ⅳ and model for end-stage liver disease (MELD) scores on hospital mortality after liver transplantation (LT).

Methods

Clinical data of 195 patients [171 males, 24 females, mean age of (48±11) years old] who underwent orthotopic LT from February 2006 to July 2009 in Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sun University were studied retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. The required parameters for APACHE IV and MELD scores and hospital mortality were collected, and the APACHE IV and MELD scores were calculated. The receiver operating characteristic (ROC) curves of discriminating patients′ mortality by two scores were drawn. The discriminability of two scores on hospital mortality were judged from the area under ROC curves (A). The discriminability was invalid when A value was <0.5, and was low when 0.5-0.7, moderate when 0.7-0.9, high when >0.9. The difference of A value between two scores were compared by Wilcoxon rank sum test.

Results

The hospital mortality of 195 patients in this study was 13.8% (27/195). The mean APACHE Ⅳ and MELD scores were (42±22), (18±11) respectively for all the patients. The mean APACHE Ⅳ and MELD scores were (36±16), (17±10) respectively for the survivals, while were (75±25), (26±13) respectively for the deaths. The A value of APACHE Ⅳ score in discriminating hospital mortality was 0.937 with a high discrimination. The A value of MELD score in discriminating hospital mortality was 0.694 with a low discrimination. The discriminability of APACHE Ⅳ score was higher than that of MELD score (Z=3,493, P<0.05). The predictive cutoff point of APACHE Ⅳ score was 56 with the sensitivity 0.85, specificity 0.91 and Youden index 0.76. The predictive cutoff point of MELD score was 20 with the sensitivity 0.70, specificity 0.72 and Youden index 0.43.

Conclusions

Compared with MELD score, the discriminability of APACHE Ⅳ score on hospital mortality after liver transplantation is higher, and the sensitivity and specificity are also higher.

Key words: Liver transplantation, Acute physiology and chronic health evaluation, Hospital mortality, Intensive care, Diagnosis, differential

Yue-yun HU, Bo LIU, Jun YAN, Tie-hua LI, Ying-ying MA, Ai-ling HU. Discriminability of acute physiology and chronic health evaluation Ⅳ and model for end-stage liver disease scores on mortality after liver transplantation[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2013, 02(05): 314-317.

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References 18

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