Discordance in categorization of acute-on-chronic liver failure in the United Network for Organ Sharing database

Lee, Brian P.; Cullaro, Giuseppe; Vosooghi, Aidan; Yao, Frederick; Goldberg, David S.; Terrault, Norah A.; Mahmud, Nadim

doi:10.1016/j.jhep.2021.12.040

Cited by 15 publications

(5 citation statements)

References 12 publications

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“…Selected ACLF organ failures, such as respiratory failure, may have been misclassified due to lack of fraction of inspired oxygen data, though in general the granularity of data afforded in the VHA is a major strength in classifying ACLF relative to national registry data. 46 Second, there is also the potential for bias due to residual confounding, but we believe our use of multiple different models and careful application of sensitivity analyses ensure that our findings are reliable. It is important to acknowledge that presence of specialty palliative care consultation is not synonymous with receipt of high-quality, goal-concordant care; however, there is strong evidence to suggest that consultation is associated with the achievement of several patient-centered outcomes.…”

Section: Discussionmentioning

confidence: 83%

Rates, patterns, and predictors of specialty palliative care consultation among patients with acute-on-chronic liver failure

Patel,

Walling,

Kanwal

et al. 2024

JHEP Reports

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Section: Discussionmentioning

confidence: 83%

Rates, patterns, and predictors of specialty palliative care consultation among patients with acute-on-chronic liver failure

Patel,

Walling,

Kanwal

et al. 2024

JHEP Reports

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“…However, it is far from the intent or the scope of this work to address how it is to be incorporated in the organ allocation process, such as the suitable operational definition of ACLF for organ allocation decisions, whether there should be separate category similar to fulminant liver failure, or whether or how many exception points should be allocated. It has been pointed out that the OPTN data are not well suited to address these questions, as certain variables are not available at all (e.g., mean arterial pressure and blood oxygen levels) and their surrogates (e.g., vasopressor use and mechanical ventilation) are only recorded at listing and transplantation 18. For our work purpose, we believe that the degree to which ACLF was incorporated in the analysis is sufficient to recognize the pattern of escalating mortality attributable to MELD 3.0 > 40.…”

Section: Discussionmentioning

confidence: 99%

“…It has been pointed out that the OPTN data are not well suited to address these questions, as certain variables are not available at all (e.g., mean arterial pressure and blood oxygen levels) and their surrogates (e.g., vasopressor use and mechanical ventilation) are only recorded at listing and transplantation. [18] For our work purpose, we believe that the degree to which ACLF was incorporated in the analysis is sufficient to recognize the pattern of escalating mortality attributable to MELD 3.0 > 40.…”

Section: Discussionmentioning

confidence: 99%

Mortality in patients with end‐stage liver disease above model for end‐stage liver disease 3.0 of 40

et al. 2022

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Background and Aims: Since the implementation of the model for endstage liver disease (MELD) score to determine waitlist priority for liver transplant (LT) in 2002, the score has been capped at 40. Recently, the MELD 3.0 score was proposed to improve upon MELD-Na. Here, we examine waitlist mortality and LT outcomes in patients with MELD 3.0 ≥ 40 to assess the potential impact of uncapping the score. Approach and Results: Adult waitlist registrations for LT from January 2016 to December 2021 were identified in the registry data from the Organ Procurement and Transplant Network. All MELD 3.0 scores were calculated at registration and thereafter. Waitlist mortality for up to 30 days was calculated as well as post-LT survival. There were 54,060 new waitlist registrations during the study period, of whom 2820 (5.2%) had MELD 3.0 ≥ 40 at listing. The 30-day waitlist mortality was high in these patients, yet it increased further in proportion with MELD 3.0 up to a score of 55 with 30-day mortality of 58.3% for MELD 3.0 of 40-44 and 82.4% for ≥ 50. The multivariable hazard ratio was 1.13 for each point of MELD 3.0, adjusting for several variables including acute-on-chronic liver failure. The number of LT recipients with MELD 40 at transplant increased from 155 in 2002 to 752 in 2021. Posttransplant survival was comparable across MELD strata including MELD of 35-39. Conclusion: MELD 3.0 scores beyond 40 are associated with increasing waitlist mortality without adversely affecting posttransplant outcome. Uncapping the MELD score in waitlist candidates may lead to greater survival benefit from LT.

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“…Parameters, including baseline demographic and laboratory data, perioperative variables for evaluating risk scores, and survival, were collected from the fully computerized database extraction software. Since ACLF is a dynamic disease that can rapidly change over time [ 6 ], all the data required to compute the risk scores were updated at the time of LT when variables were measured repeatedly.…”

Section: Methodsmentioning

confidence: 99%

Neutrophilia is more predictive than increased white blood cell counts for short-term mortality after liver transplantation in patients with acute-on-chronic liver failure

Kim,

Kwon

et al. 2023

Anesth Pain Med

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Background: Acute-on-chronic liver failure (ACLF) is a life-threatening disease that requires urgent liver transplantation (LT). Accurate identification of high-risk patients is essential for predicting post-LT survival. The chronic liver failure consortium ACLF score is a widely accepted risk-stratification score that includes total white blood cell (WBC) counts as a component. This study aimed to evaluate the predictive value of total and differential WBC counts for short-term mortality following LT in patients with ACLF.Methods: A total of 685 patients with ACLF who underwent LT between January 2008 and February 2019 were analyzed. Total and differential WBC counts were examined as a function of the model for end-stage liver disease for sodium (MELD-Na) score. The association between total and differential WBC counts and 90-day post-LT mortality was assessed using multivariable Cox proportional hazards regression analysis.Results: The total WBC counts and neutrophil ratio were higher in patients with ACLF than in those without ACLF. The neutrophil ratio was significantly associated with 90-day post-LT mortality after adjustment (hazard ratio [HR], 1.04; P = 0.001), whereas total WBC counts were not significantly associated with 90-day post-LT mortality in either univariate or multivariate Cox analyses. The neutrophil ratio demonstrated a relatively linear trend with an increasing MELD-Na score and HR for 90-day post-LT mortality, whereas the total WBC counts exhibited a plateaued pattern.Conclusions: Neutrophilia, rather than total WBC counts, is a better prognostic indicator for short-term post-LT mortality in patients with ACLF.

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Discordance in categorization of acute-on-chronic liver failure in the United Network for Organ Sharing database

Cited by 15 publications

References 12 publications

Rates, patterns, and predictors of specialty palliative care consultation among patients with acute-on-chronic liver failure

Rates, patterns, and predictors of specialty palliative care consultation among patients with acute-on-chronic liver failure

Mortality in patients with end‐stage liver disease above model for end‐stage liver disease 3.0 of 40

Neutrophilia is more predictive than increased white blood cell counts for short-term mortality after liver transplantation in patients with acute-on-chronic liver failure

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