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. 2015 May;3(2):122-7.
doi: 10.1093/gastro/gou075. Epub 2014 Nov 11.

Change in model for end-stage liver disease score at two weeks, as an indicator of mortality or liver transplantation at 60 days in acute-on-chronic liver failure

Rajneesh Kumar  1 , Thinesh Lee Krishnamoorthy  2 , Hiang Keat Tan  2 , Hock Foong Lui  2 , Wan Cheng Chow  2
Affiliations

Change in model for end-stage liver disease score at two weeks, as an indicator of mortality or liver transplantation at 60 days in acute-on-chronic liver failure

Rajneesh Kumar et al. Gastroenterol Rep (Oxf). 2015 May.

Abstract

Background: Acute-on-chronic liver failure (ACLF) is characterised by a sudden deterioration of underlying chronic liver disease, resulting in increased rates of mortality and liver transplantation. Early prognostication can benefit optimal allocation of resources.

Methods: ACLF was defined as per the disease criteria of the Asian Pacific Association for the Study of the Liver. Inpatient discharge summaries from between January 2001 and April 2013 were reviewed. The primary outcome was mortality or liver transplantation within 60 days from onset of ACLF. Absolute 'model for end-stage liver disease' (MELD) score and change in MELD at Weeks 1, 2 and 4 were reviewed in order to identify the earliest point for prediction of mortality or liver transplantation.

Results: Clinical data were collected on 53 subjects who fulfilled the inclusion and exclusion criteria. At 60 days from presentation, 20 patients (37.7%) died and 4 (7.5%) underwent liver transplantation. Increased MELD of ≥2 after 2 weeks was 75.0% sensitive and 75.9% specific for predicting mortality or liver transplantation. If the MELD score did not increase at 2 weeks, predictive chance of survival was 93.8% over the next 60 days. MELD change at 1 week showed poor sensitivity and specificity. Change at 4 weeks was too late for intervention.

Conclusion: Change in MELD score at 2 weeks provides an early opportunity for prognostication in ACLF. A MELD score that does not deteriorate by Week 2 would predict 93.8% chance of survival for the next 60 days. This finding warrants further validation in larger cohort studies.

Keywords: acute-on-chronic liver failure; liver transplantation; model for end-stage liver disease (MELD) score; mortality.

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Figures

Figure 1.
Figure 1.
Model for end-stage liver disease change at 1 week. MELD change = MELD at 1 week minus MELD at presentation. PPV = positive predictive value; NPV = negative predictive value
Figure 2.
Figure 2.
Model for end-stage liver disease change at 2 weeks. MELD change = MELD at 2 weeks minus MELD at presentation. PPV = positive predictive value; NPV = negative predictive value
Figure 3.
Figure 3.
Improvement in MELD at 2 weeks. Straight line = MELD improved at 2 weeks. Broken line = MELD worsened at 2 weeks or remained the same. Log rank test P < 0.001
See this image and copyright information in PMC

References

    1. 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. - PubMed
    1. 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. - PMC - PubMed
    1. Jalan R, Williams R. Acute-on-chronic liver failure: pathophysiological basis of therapeutic options. Blood Purif 2002;20:252–61. - PubMed
    1. O'Grady J, Alexander G, Hayllar K, et al. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 1989;97:439–45. - PubMed
    1. 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. - PubMed