目的 评估排除国际标准化比值（INR）的改良版终末期肝病模型（MELD-XI）评分对老年心脏瓣膜术后患者长期全因死亡率的预测价值。 方法 回顾性纳入2013年1—12月于医院接受心脏瓣膜手术的263例老年患者（≥ 65岁）。根据术前总胆红素及血肌酐计算MELD-XI评分，并获取其长期生存状态。根据受试者工作特征曲线确定的最佳截断值，将患者分为低值组（≤ 11.82）和高值组（> 11.82）。采用单因素及多因素Cox比例风险回归模型分析MELD-XI评分与长期随访死亡风险的相关性，并通过Kaplan-Meier生存曲线及亚组分析进行验证。 结果 中位随访时间为7.9年，共60例患者死亡。多因素Cox回归分析显示，MELD-XI评分每增加1分，死亡风险增加9%（HR = 1.09， 95%CI：1.03 ~ 1.16，P = 0.002 4）。高值组死亡风险显著高于低值组（HR = 2.36，95%CI：1.29 ~ 4.35， P = 0.005 6）。亚组分析显示，MELD-XI评分的预测价值在不同临床特征的患者中一致（交互作用P均> 0.05）。Kaplan-Meier生存曲线证实高值组累积死亡率高于低值组（Log-rank P = 0.000 52）。 结论 术前MELD-XI评分是老年心脏瓣膜术后患者长期死亡风险的独立危险因素，评分越高，预后越差。

Objective To evaluate the predictive value of the Model for End-Stage Liver Disease Excluding International Normalized Ratio （MELD-XI） score for long-term all-cause mortality in elderly patients after cardiac valve surgery. Methods This retrospective study incorporated 263 elderly patients （aged ≥ 65 years） who underwent cardiac valve surgery at the hospital between January and December 2013. The MELD-XI score was computed based on the preoperative levels of total bilirubin and serum creatinine， and the long-term survival status was acquired. Patients were classified into a low-score group （≤ 11.82） and a high-score group （> 11.82） according to the optimal cut-off value determined by receiver operating characteristic curve analysis. Univariate and multivariate Cox proportional hazards regression models were employed to analyze the association between the MELD-XI score and long-term mortality， which was validated by Kaplan-Meier survival curves and subgroup analysis. Results Over a median follow-up period of 7.9 years， 60 patients passed away. Multivariate Cox regression analysis indicated that for every 1-point increment in the MELD-XI score， there was a 9% rise in the mortality risk （HR = 1.09， 95%CI： 1.03 - 1.16， P = 0.002 4）. The high-score group exhibited a significantly greater mortality risk when compared to the low-score group （HR = 2.36， 95%CI： 1.29 - 4.35， P = 0.005 6）. Subgroup analysis revealed a consistent predictive value among patients with different clinical characteristics （all interaction P-values > 0.05）. Kaplan-Meier survival curves verified a significantly higher cumulative mortality in the high-score group （Log-rank P = 0.000 52）. Conclusion The preoperative MELD-XI score serves as an independent predictor of the long-term mortality risk in elderly patients following cardiac valve surgery， where higher scores are indicative of a poorer prognosis.