Model for end-stage liver disease score as a predictor of short-term outcome in patients with drug-induced liver injury

Jeong, Rubi; Lee, Yoon‐Seon; Sohn, Cheol Ho; Jeon, Jin Yeong; Kim, Won Young; Lim, Kyoung Soo

doi:10.3109/00365521.2014.958094

Cited by 23 publications

(24 citation statements)

References 30 publications

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“…Our results also show that sex, age, latencies and DILI type are not correlated with DILI-associated mortality. This finding is consistent with studies from the USA (Chalasani et al 2015 ) and Korea (Jeong et al 2015 ). The data from the US study showed that the DILI-associated mortality was significantly higher in individuals with pre-existing liver disease (Chalasani et al 2015 ).…”

Section: Discussionsupporting

confidence: 93%

“…The MELD score is widely accepted as an accurate predictor of mortality across a broad spectrum of liver diseases (Said et al 2004 ; Martin et al 2014 ). The study from Korea also confirmed that the c-statistic for the MELD score alone was 0.93 and that the MELD score had strong discriminatory power and may be a reliable predictor of the prognosis in patients with DILI (Jeong et al 2015 ).…”

Section: Discussionmentioning

confidence: 71%

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Causes, clinical features and outcomes of drug-induced liver injury in hospitalized patients in a Chinese tertiary care hospital

Chen²,

et al. 2015

SpringerPlus

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Drug-induced liver injury (DILI) is an important liver disease in China, owing to the country’s huge population and the availability of a multitude of drugs. Consequently, DILI is becoming an increasingly serious health problem. However, there is not enough relevant epidemiological data, and the clinical features of these patients are not clear. We conducted this study to report the causes and clinical features of DILI in hospitalized patients, and identify the mortality and predictive factors. We retrospectively collected and analyzed the data of all hospitalized patients whose discharge diagnosis was DILI at the Second Xiangya Hospital between January 2011 and December 2014. The data analyses were performed using SAS version 9.2. Among the 469 patients who were diagnosed with DILI at discharge, 361 met the criteria for DILI on re-evaluation. The crude annual incidence rate of DILI was 92.95 cases per 100,000 patients. Chinese herbal medicine was identified as the primary cause of DILI in 36.01 % of the patients. The overall mortality was 8.59 %. Alcohol consumption, use of antituberculosis drugs, serum total bilirubin, direct bilirubin, total protein, albumin, thrombinogen time, international normalized ratio, and the model for end-stage liver disease (MELD) score were significantly correlated with DILI-associated mortality. Among them, the MELD score and albumin were found to be independent predictors of outcome in patients with DILI. Chinese herbal medicine was the primary cause of DILI in the identified patients. The MELD score and albumin were independent predictors of outcome in patients with DILI.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 71%

Causes, clinical features and outcomes of drug-induced liver injury in hospitalized patients in a Chinese tertiary care hospital

Chen²,

et al. 2015

SpringerPlus

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“…Since Model for End-Stage Liver Disease (MELD) score may predict mortality among DILI patients, 15 we examined the accuracy of different MELD score cut-offs for incident ALF. Among KPNC patients who had INR measured at DILI diagnosis, MELD score was calculated by: 3.78*ln[total bilirubin (mg/dL)] + 11.2*ln[INR] + 9.57*ln[creatinine (mg/dL)] + 6.43.…”

Section: Methodsmentioning

confidence: 99%

Risk of Acute Liver Failure in Patients With Drug-Induced Liver Injury: Evaluation of Hy’s Law and a New Prognostic Model

Haynes

Forde

et al. 2015

Clinical Gastroenterology and Hepatology

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Background & Aims Few studies have evaluated the ability of laboratory tests to predict risk of acute liver failure (ALF) among patients with drug-induced liver injury (DILI). We aimed to develop a highly sensitive model to identify DILI patients at increased risk of ALF. We compared its performance with that of Hy’s Law, which predicts severity of DILI based on levels of alanine aminotransferase or aspartate aminotransferase and total bilirubin, and validated the model in a separate sample. Methods We conducted a retrospective cohort study of 15,353 Kaiser Permanente Northern California members diagnosed with DILI from 2004 through 2010, liver aminotransferase levels above the upper limit of normal, and no pre-existing liver disease. Thirty ALF events were confirmed by medical record review. Logistic regression was used to develop prognostic models for ALF based on laboratory results measured at DILI diagnosis. External validation was performed in a sample of 76 patients with DILI at the University of Pennsylvania. Results Hy’s Law identified patients that developed ALF with a high level of specificity (0.92) and negative predictive value (0.99), but low level of sensitivity (0.68) and positive predictive value (0.02). The model we developed, comprising data on platelet count and total bilirubin level, identified patients with ALF with a C statistic of 0.87 (95% confidence interval [CI], 0.76–0.96) and enabled calculation of a risk score (Drug-Induced Liver Toxicity ALF Score). We found a cut-off score that identified patients at high risk patients for ALF with a sensitivity value of 0.91 (95% CI, 0.71–0.99) and a specificity value of 0.76 (95% CI, 0.75–0.77). This cut-off score identified patients at high risk for ALF with a high level of sensitivity (0.89; 95% CI, 0.52–1.00) in the validation analysis. Conclusions Hy’s Law identifies patients with DILI at high risk for ALF with low sensitivity but high specificity. We developed a model (the Drug-Induced Liver Toxicity ALF Score) based on platelet count and total bilirubin level that identifies patients at increased risk for ALF with high sensitivity.

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“…Cholestatic DILI usually will generally resolve within 3–12 months after the withdrawal of hepatoxic drugs [80], but a few of those patients may have prolonged course and finally develop into severe vanishing bile duct syndrome and cholestatic cirrhosis, which indicates a poor prognosis. A retrospective study of South Korea [142] suggested that the percentage of 30-day poor prognosis after admission was up to 13.1% among 213 patients with DILI. In addition, the Model for End-Stage Liver Disease (MELD) score and the level of hemoglobin were found to be independent predictors for short-term prognosis of those patients, while the clinical patterns of liver injury (hepatocellular injury, mixed or cholestatic pattern) upon admission were less correlated with the short-term prognosis at 30 days.…”

Section: Prognosis Of Dilimentioning

confidence: 99%

CSH guidelines for the diagnosis and treatment of drug-induced liver injury

et al. 2017

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Drug-induced liver injury (DILI) is an important clinical problem, which has received more attention in recent decades. It can be induced by small chemical molecules, biological agents, traditional Chinese medicines (TCM), natural medicines (NM), health products (HP), and dietary supplements (DS). Idiosyncratic DILI is far more common than intrinsic DILI clinically and can be classified into hepatocellular injury, cholestatic injury, hepatocellular-cholestatic mixed injury, and vascular injury based on the types of injured target cells. The CSH guidelines summarized the epidemiology, pathogenesis, pathology, and clinical manifestation and gives 16 evidence-based recommendations on diagnosis, differential diagnosis, treatment, and prevention of DILI.

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Model for end-stage liver disease score as a predictor of short-term outcome in patients with drug-induced liver injury

Abstract: The outcome of patients with DILI was poor. MELD score and Hb were reliable predictors of short-term outcome in patients with DILI.

Cited by 23 publications

References 30 publications

Causes, clinical features and outcomes of drug-induced liver injury in hospitalized patients in a Chinese tertiary care hospital

Causes, clinical features and outcomes of drug-induced liver injury in hospitalized patients in a Chinese tertiary care hospital

Risk of Acute Liver Failure in Patients With Drug-Induced Liver Injury: Evaluation of Hy’s Law and a New Prognostic Model

CSH guidelines for the diagnosis and treatment of drug-induced liver injury

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