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. 2015 Sep;35(9):2167-73.
doi: 10.1111/liv.12792. Epub 2015 Feb 12.

Clinician assessments of health status predict mortality in patients with end-stage liver disease awaiting liver transplantation

Jennifer C Lai  1 , Kenneth E Covinsky  1 , Hilary Hayssen  1 , Blanca Lizaola  2 , Jennifer L Dodge  1 , John P Roberts  2 , Norah A Terrault  1 , Sandy Feng  3
Affiliations

Clinician assessments of health status predict mortality in patients with end-stage liver disease awaiting liver transplantation

Jennifer C Lai et al. Liver Int. 2015 Sep.

Abstract

Background & aims: The US liver allocation system effectively prioritizes most liver transplant candidates by disease severity as assessed by the Model for End-Stage Liver Disease (MELD) score. Yet, one in five dies on the wait-list. We aimed to determine whether clinician assessments of health status could identify this subgroup of patients at higher risk for wait-list mortality.

Methods: From 2012-2013, clinicians of all adult liver transplant candidates with laboratory MELD≥12 were asked at the clinic visit: 'How would you rate your patient's overall health today (0 = excellent, 5 = very poor)?' The odds of death/delisting for being too sick for the transplant by clinician-assessment score ≥3 vs. <3 were assessed by logistic regression.

Results: Three hundred and forty-seven liver transplant candidates (36% female) had a mean follow-up of 13 months. Men differed from women by disease aetiology (<0.01) but were similar in age and markers of liver disease severity (P > 0.05). Mean clinician assessment differed between men and women (2.3 vs. 2.6; P = 0.02). The association between clinician-assessment and MELD was ρ = 0.28 (P < 0.01). 53/347 (15%) died/were delisted. In univariable analysis, a clinician-assessment score ≥ 3 was associated with increased odds of death/delisting (2.57; 95% CI 1.42-4.66). After adjustment for MELD and age, a clinician-assessment score ≥ 3 was associated with 2.25 (95% CI 1.22-4.15) times the odds of death/delisting compared to a clinician-assessment score < 3.

Conclusions: A standardized clinician assessment of health status can identify liver transplant candidates at high risk for wait-list mortality independent of MELD score. Objectifying this 'eyeball test' may inform interventions targeted at this vulnerable subgroup to optimize wait-list outcomes.

Keywords: clinical judgment; health status; wait-list mortality.

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Conflict of interest statement

Disclosures: The authors of this manuscript have no conflicts of interest to disclose as described by Liver International.

Figures

Figure
Figure
Percent of wait-list candidates who died/were delisted by MELD (< 18 vs. ≥ 18) and clinician-assessment (<3 vs. ≥ 3 out of 5) strata.
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References

    1. Kamath P. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33:464–470. - PubMed
    1. Freeman RB, Wiesner RH, Edwards E, et al. Results of the first year of the new liver allocation plan. Liver Transpl. 2004;10:7–15. - PubMed

    1. Based on OPTN data as of March 15, 2013.

    1. Lai JC, Feng S, Roberts JP. An Examination of Liver Offers to Candidates on the Liver Transplant Wait-List. Gastroenterology. 2012;143:1261–1265. - PMC - PubMed
    1. McGee DL, Liao Y, Cao G, et al. Self-reported health status and mortality in a multiethnic US cohort. Am J Epidemiol. 1999;149:41–46. - PubMed

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