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. 2009 Jun 14;15(22):2768-77.
doi: 10.3748/wjg.15.2768.

Application of a biochemical and clinical model to predict individual survival in patients with end-stage liver disease

Eduardo Vilar Gomez  1 , Luis Calzadilla Bertot, Bienvenido Gra Oramas, Enrique Arus Soler, Raimundo Llanio Navarro, Javier Diaz Elias, Oscar Villa Jiménez, Maria del Rosario Abreu Vazquez
Affiliations

Application of a biochemical and clinical model to predict individual survival in patients with end-stage liver disease

Eduardo Vilar Gomez et al. World J Gastroenterol. .

Abstract

Aim: To investigate the capability of a biochemical and clinical model, BioCliM, in predicting the survival of cirrhotic patients.

Methods: We prospectively evaluated the survival of 172 cirrhotic patients. The model was constructed using clinical (ascites, encephalopathy and variceal bleeding) and biochemical (serum creatinine and serum total bilirubin) variables that were selected from a Cox proportional hazards model. It was applied to estimate 12-, 52- and 104-wk survival. The model's calibration using the Hosmer-Lemeshow statistic was computed at 104 wk in a validation dataset. Finally, the model's validity was tested among an independent set of 85 patients who were stratified into 2 risk groups (low risk <or= 8 and high risk > 8).

Results: In the validation cohort, all measures of fit, discrimination and calibration were improved when the biochemical and clinical model was used. The proposed model had better predictive values (c-statistic: 0.90, 0.91, 0.91) than the Model for End-stage Liver Disease (MELD) and Child-Pugh (CP) scores for 12-, 52- and 104-wk mortality, respectively. In addition, the Hosmer-Lemeshow (H-L) statistic revealed that the biochemical and clinical model (H-L, 4.69) is better calibrated than MELD (H-L, 17.06) and CP (H-L, 14.23). There were no significant differences between the observed and expected survival curves in the stratified risk groups (low risk, P = 0.61; high risk, P = 0.77).

Conclusion: Our data suggest that the proposed model is able to accurately predict survival in cirrhotic patients.

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Figures

Figure 1
Figure 1
Kaplan-Meier estimated survival curves for clinical variables. A: Ascites; B: Encephalopathy; C: Bleeding esophageal varices.
Figure 2
Figure 2
Comparison of the c-index values of the MELD, Child-Pugh and BioCliM scores for 12- (A), 52- (B) and 104-wk (C) survival. SE indicates standard errors. The different values were compared with BioCliM score using the bootstrap method.
Figure 3
Figure 3
Observed and predicted probability of events at 104 wk. A, B and C shows the observed and predicted probability of death according to BioCliM, MELD and Child-Pugh scores in 10 groups (deciles) of patients, respectively. A significant P-value for the Hosmer-Lemeshow statistic indicates a significant deviation between predicted and observed outcomes.
Figure 4
Figure 4
Observed and expected 104-wk survival curves for the BioCliM score. Survival of 85 independent patients from the “Calixto Garcia” Hospital who were stratified according to their risk score into two risk groups (low-risk ≤ 8 and high-risk > 8). The observed and predicted BioCli Model survival curves were compared using log-rank test. The observed and expected survival was similar for the low- and high-risk groups.
Figure 5
Figure 5
Kaplan-Meier estimated survival curves for the BioCli Model score.
See this image and copyright information in PMC

References

    1. Child CG, Turcotte JG. Surgery and portal hypertension. In: Child CG, editor. The Liver and Portal Hypertension. Philadelphia: W.B. Saunders Co; 1964. pp. 1–85.
    1. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60:646–649. - PubMed
    1. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D’Amico G, Dickson ER, Kim WR. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33:464–470. - PubMed
    1. Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, Kremers W, Lake J, Howard T, Merion RM, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003;124:91–96. - PubMed
    1. Freeman RB Jr, Wiesner RH, Harper A, McDiarmid SV, Lake J, Edwards E, Merion R, Wolfe R, Turcotte J, Teperman L. The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transpl. 2002;8:851–858. - PubMed