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. 2016 Aug;14(8):1189-1195.e1.
doi: 10.1016/j.cgh.2016.03.036. Epub 2016 Apr 1.

Poor Performance Status Is Associated With Increased Mortality in Patients With Cirrhosis

Eric S Orman  1 , Marwan Ghabril  2 , Naga Chalasani  2
Affiliations

Poor Performance Status Is Associated With Increased Mortality in Patients With Cirrhosis

Eric S Orman et al. Clin Gastroenterol Hepatol. 2016 Aug.

Abstract

Background & aims: Functional status (a patient's ability to perform activities that meet basic needs, fulfill usual roles, and maintain health and well-being) has been linked to outcomes in patients with cirrhosis and can be measured by the Karnofsky performance status (KPS) scale. We investigated the association between KPS score and mortality in patients with cirrhosis.

Methods: We used the United Network for Organ Sharing database to perform a retrospective cohort study of patients listed for liver transplantation in the United States between 2005 and 2015. We used Cox proportional hazards and competing risk regression analyses to examine the association between KPS and mortality and transplantation.

Results: Of 79,092 patients, 44% were in KPS category A (KPS, 80%-100%), 43% were in category B (KPS, 50%-70%), and 13% were in category C (KPS, 10%-40%). Between 2005 and 2015, the proportion of patients in category A decreased from 53% to 35%, whereas the proportions in categories B and C increased from 36% to 49% and from 11% to 16%, respectively. KPS was associated with mortality: compared with patients in KPS category A, the KPS B adjusted hazard ratio (HR) was 1.14 (95% confidence interval [CI], 1.11-1.18) and the KPS C adjusted HR was 1.63 (95% CI, 1.55-1.72). KPS was also associated with liver transplantation; compared with patients in KPS category A, the KPS B adjusted HR was 1.08 (95% CI, 1.06-1.11) and the KPS C adjusted HR was 1.35 (95% CI, 1.30-1.40). In competing risk analysis, only the relationship between KPS and mortality maintained significance and directionality. These relationships were most pronounced in patients without hepatocellular carcinoma.

Conclusions: Among patients with cirrhosis listed for liver transplantation, poor performance status, based on the KPS scale, is associated with increased mortality. In this population, performance status has decreased over time.

Keywords: Death; Liver Disease; Survival; UNOS; Waitlist.

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Conflict of interest statement

Disclosures: The authors have no potential conflicts to disclose.

Figures

Figure 1
Figure 1
Temporal changes in Karnofsky performance status of patients listed for liver transplantation in the United States.
Figure 2
Figure 2
Five-year cumulative incidences of death/deterioration and liver transplantation according to Karnofsky performance status.
Figure 3
Figure 3
Relationship between Karnofsky performance status and clinical outcomes in patients with and without hepatocellular carcinoma. Estimates and confidence intervals are based on the multivariable Cox proportional hazards models.
Figure 4
Figure 4
Relationship between Karnofsky performance status and clinical outcomes in patients with and without hepatocellular carcinoma. Estimates and confidence intervals are based on the multivariable competing risk models.
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References

    1. Leidy NK. Functional status and the forward progress of merry-go-rounds: toward a coherent analytical framework. Nurs Res. 1994;43:196–202. - PubMed
    1. Tapper EB, Finkelstein D, Mittleman MA, et al. Standard assessments of frailty are validated predictors of mortality in hospitalized patients with cirrhosis. Hepatology. 2015;62:584–90. - PMC - PubMed
    1. Lai JC, Feng S, Terrault NA, et al. Frailty predicts waitlist mortality in liver transplant candidates. Am J Transplant. 2014;14:1870–9. - PMC - PubMed
    1. Carey EJ, Steidley DE, Aqel BA, et al. Six-minute walk distance predicts mortality in liver transplant candidates. Liver Transpl. 2010;16:1373–8. - PubMed
    1. Derck JE, Thelen AE, Cron DC, et al. Quality of life in liver transplant candidates: frailty is a better indicator than severity of liver disease. Transplantation. 2015;99:340–4. - PubMed

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