Wen-Bin Y, En-Qiang C, Hong-Xia B, Lang B, Xue-Bin C, Ping F, Hong T

Language: English
References: 34
Page: 311-319
PDF size: 131.07 Kb.

ABSTRACT

Background and aims. Effective assessing the prognosis of patients with end-stage liver disease is always challenging. This study aimed to investigate the accuracy of different models in predicting short-term prognosis of patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF). Material and methods. We retrospectively evaluated survival of a cohort of patients with at least 3-month follow up. The receiver-operating-characteristic curves (ROC) were drawn for Child-Turcotte-Pugh (CTP) classification, King’s College Hospital (KCH) criteria, model for end-stage liver disease (MELD), MELD combined with serum sodium (Na) concentration (MELDNa), integrated MELD (iMELD) and logistic regression model (LRM). Results. Of the 273 eligible patients, 152 patients (55.7%) died within 3-month follow up. In cirrhotic patients (n = 101), the AUCs of LRM (0.851), MELDNa (0.849), iMELD (0.845) and MELD (0.840) were all significantly higher than those of KCH criteria (0.642) and CTP (0.625) (all p ‹ 0.05), while the differences among LRM, MELD, MELDNa and iMELD were not significant, and the most predictive cutoff value was 0.5176 for LRM, 30 for MELDNa, 47.87 for iMELD and 29 for MELD, respectively. In non-cirrhotic patients (n = 172), the AUC of LRM (0.897) was significantly higher than that of MELDNa (0.776), iMELD (0.768), MELD (0.758), KCH criteria (0.647) and CTP (0.629), respectively (all p ‹ 0.05), and the most predictive cutoff value for LRM was -0.3264. Conclusions. LRM, MELD, MELDNa and iMELD are with similar accuracy in predicting the shortterm prognosis of HBV-ACLF patients with liver cirrhosis, while LRM is superior to MELD, MELDNa and iMELD in predicting the short-term prognosis of HBV-ACLF patients without liver cirrhosis.

REFERENCES

1. Lee WM. Hepatitis B virus infection. N Engl J Med 1997; 337: 1733-45.

2. Merle P, Trepo C, Zoulim F. Current management strategies for hepatitis B in the elderly. Drugs & aging 2001; 18: 725-35.

3. Sarin SK, Kumar A, Almeida JA, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL). Hepatol Int 2009; 3: 269-82.

4. Katoonizadeh A, Laleman W, Verslype C, et al. Early features of acute-on-chronic alcoholic liver failure: a prospective cohort study. Gut 2010; 59: 1561-9.

5. Graziadei IW. The clinical challenges of acute on chronic liver failure. Liver Int 2011; 31 (Suppl. 3): 24-6.

6. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973; 60: 646-9.

7. O’Grady JG, Alexander GJ, Hayllar KM, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 1989; 97: 439-45.

8. Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001; 33: 464-70.

9. Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med 2008; 359: 1018-26.

10. Biggins SW, Kim WR, Terrault NA, et al. Evidence-based incorporation of serum sodium concentration into MELD. Gastroenterology 2006; 130: 1652-60.

11. Huo TI, Wang YW, Yang YY, et al. Model for end-stage liver disease score to serum sodium ratio index as a prognostic predictor and its correlation with portal pressure in patients with liver cirrhosis. Liver Int 2007; 27: 498-506.

12. Luca A, Angermayr B, Bertolini G, et al. An integrated MELD model including serum sodium and age improves the prediction of early mortality in patients with cirrhosis. Liver Transpl 2007; 13: 1174-80.

13. Huo TI, Lin HC, Huo SC, et al. Comparison of four model for end-stage liver disease-based prognostic systems for cirrhosis. Liver Transpl 2008; 14: 837-44.

14. Zhang JY, Zhang FK, Wang BE, Jia JD, Zhang ST. The prognostic value of end-stage liver disease model in liver cirrhosis. Zhonghua Nei Ke Za Zhi 2005; 44: 822-4.

15. Botta F, Giannini E, Romagnoli P, et al. MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study. Gut 2003; 52: 134-9.

16. Cho HC, Jung HY, Sinn DH, et al. Mortality after surgery in patients with liver cirrhosis: comparison of Child-Turcotte- Pugh, MELD and MELDNa score. Eur J Gastroenterol Hepatol 2011; 23: 51-9.

17. Boursier J, Cesbron E, Tropet AL, Pilette C. Comparison and improvement of MELD and Child-Pugh score accuracies for the prediction of 6-month mortality in cirrhotic patients. J Clin Gastroenterol 2009; 43: 580-5.

18. Jiang M, Liu F, Xiong WJ, Zhong L, Chen XM. Comparison of four models for end-stage liver disease in evaluating the prognosis of cirrhosis. World J Gastroenterol 2008; 14: 6546-50.

19. Shakil AO, Kramer D, Mazariegos GV, Fung JJ, Rakela J. Acute liver failure: clinical features, outcome analysis, and applicability of prognostic criteria. Liver Transpl 2000; 6: 163-9.

20. Anand AC, Nightingale P, Neuberger JM. Early indicators of prognosis in fulminant hepatic failure: an assessment of the King’s criteria. J Hepatol 1997; 26: 62-8.

21. Sun QF, Ding JG, Xu DZ, et al. Prediction of the prognosis of patients with acute-on-chronic hepatitis B liver failure using the model for end-stage liver disease scoring system and a novel logistic regression model. J Viral Hepat 2009; 16: 464-70.

22. Radha Krishna Y, Saraswat VA, Das K, et al. Clinical features and predictors of outcome in acute hepatitis A and hepatitis E virus hepatitis on cirrhosis. Liver Int 2009; 29: 392-8.

23. He WP, Hu JH, Tong JJ, Liu FF, Wang HF. Comparison of MELD-Na versus MELDNa in the prediction of short-term prognosis for acute-on-chronic hepatitis B liver failure. Zhonghua Yi Xue Za Zhi 2011; 91: 1173-7.

24. Zheng MH, Shi KQ, Fan YC, et al. A model to determine 3- month mortality risk in patients with acute-on-chronic hepatitis B liver failure. Clin Gastroenterol Hepatol 2011; 9: 351-356 e3.

25. Riordan SM, Williams R. Treatment of hepatic encephalopathy. N Engl J Med 1997; 337: 473-9.

26. Christensen E, Schlichting P, Fauerholdt L, et al. Prognostic value of Child-Turcotte criteria in medically treated cirrhosis. Hepatology 1984; 4: 430-5.

27. Infante-Rivard C, Esnaola S, Villeneuve JP. Clinical and statistical validity of conventional prognostic factors in predicting short-term survival among cirrhotics. Hepatology 1987; 7: 660-4.

28. Li Q, Wang BE, Jia JD. The evolution and characteristics of liver function classification: from Child to MELD. Zhonghua Gan Zang Bing Za Zhi 2004; 12: 319-20.

29. Freeman RB Jr., Wiesner RH, Harper A, et al. The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transpl 2002; 8: 851-8.

30. Cholongitas E, Papatheodoridis GV, Vangeli M, Terreni N, Patch D, Burroughs AK. Systematic review: The model for end-stage liver disease—should it replace Child- Pugh’s classification for assessing prognosis in cirrhosis? Alimentary pharmacology & therapeutics 2005; 22: 1079-89.

31. Durand F, Valla D. Assessment of the prognosis of cirrhosis: Child-Pugh versus MELD. J Hepatol 2005; 42(Suppl.): S100-S107.

32. Cholongitas E, Marelli L, Shusang V, et al. A systematic review of the performance of the model for end-stage liver disease (MELD) in the setting of liver transplantation. Liver Transpl 2006; 12: 1049-61.

33. Liu XY, Hu JH, Wang HF. Analysis of prognostic factors for patients with acute-on-chronic liver failure. Zhonghua Gan Zang Bing Za Zhi 2009; 17: 607-10.

34. Huang K, Hu JH, Wang HF, et al. Survival and prognostic factors in hepatitis B virus-related acute-on-chronic liver failure. World J Gastroenterol 2011; 17: 3448-52.