Performance of the model for end-stage liver disease score for mortality prediction and the potential role of etiology

D’Amico, Gennaro; Maruzzelli, Luigi; Airoldi, Aldo; Petridis, Ioannis; Tosetti, Giulia; Rampoldi, Antonio; D’Amico, Mario; Miraglia, Roberto; Nicola, S. De; Mura, Vincenzo La; Solcia, Marco; Volpes, Riccardo; Sgrazzutti, Cristiano; Vanzulli, Angelo; Primignani, Massimo; Luca, Angelo; Malizia, Giuseppe; Federico, Alessandro Di; Dallio, Marcello; Andriulli, Angelo; Iacobellis, A.; Addario, Luigi; Garcovich, Matteo; Gasbarrini, Antonio; Chessa, Luchino; Salerno, Francesco; Gobbo, Giulia; Merli, Manuela; Baroni, G. Svegliati; Tarantino, Giuseppe; Caporaso, Nicola; Morisco, Filomena; Pozzoni, Pietro; Colli, Agostino; Belli, Luca

doi:10.1016/j.jhep.2021.07.018

Cited by 17 publications

(17 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar performance, both for discrimination and calibration, was recently reported for MELD and FIPS scores. [6,9] It should be acknowledged that our prediction model overestimates the 2-year risk of liver-related death in older adults. This could result in a more conservative selection of patients in the older adult population.…”

Section: Discussionmentioning

confidence: 94%

See 1 more Smart Citation

Mortality after transjugular intrahepatic portosystemic shunt in older adult patients with cirrhosis: A validated prediction model

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background and Aims: Implantation of a transjugular intrahepatic portosystemic shunt (TIPS) improves survival in patients with cirrhosis with refractory ascites and portal hypertensive bleeding. However, the indication for TIPS in older adult patients (greater than or equal to 70 years) is debated, and a specific prediction model developed in this particular setting is lacking. The aim of this study was to develop and validate a multivariable model for an accurate prediction of mortality in older adults. Approach and Results: We prospectively enrolled 411 consecutive patients observed at four referral centers with de novo TIPS implantation for refractory ascites or secondary prophylaxis of variceal bleeding (derivation cohort) and an external cohort of 415 patients with similar indications for TIPS (validation cohort). Older adult patients in the two cohorts were 99 and 76, respectively. A cause‐specific Cox competing risks model was used to predict liver‐related mortality, with orthotopic liver transplant and death for extrahepatic causes as competing events. Age, alcoholic etiology, creatinine levels, and international normalized ratio in the overall cohort, and creatinine and sodium levels in older adults were independent risk factors for liver‐related death by multivariable analysis. Conclusions: After TIPS implantation, mortality is increased by aging, but TIPS placement should not be precluded in patients older than 70 years. In older adults, creatinine and sodium levels are useful predictors for decision making. Further efforts to update the prediction model with larger sample size are warranted.

show abstract

Section: Discussionmentioning

confidence: 94%

“…Moreover, they were developed without considering OLT and extrahepatic death as events competing with liver‐related death and were not specifically derived and validated in older adults. Finally, the discriminative accuracy remains the main focus in the evaluation of performance, whereas calibration often receives less attention 9…”

Section: Introductionmentioning

confidence: 99%

Mortality after transjugular intrahepatic portosystemic shunt in older adult patients with cirrhosis: A validated prediction model

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…A recent multicenter study suggested that the Mayo TIPS score slightly overestimated the mortality risk when used in the TIPS setting and that the Mayo MELD and MELD UNOS scores substantially overestimated the mortality risk. 43 Interestingly, the same study also highlighted that the Mayo MELD and MELD UNOS are not broadly generalizable because of the lower discrimination and calibration observed in nonviral etiology compared to those in viral etiology. Third, malnutrition is a frequent complication of advanced cirrhosis and has been identified as an independent predictor of poor prognosis.…”

Section: The Meld Scorementioning

confidence: 98%

A comprehensive review of prognostic scoring systems to predict survival after transjugular intrahepatic portosystemic shunt placement

Yang

Xiong

2022

Portal Hypertension & Cirrhosis

View full text Add to dashboard Cite

Patient prognosis after transjugular intrahepatic portosystemic shunt (TIPS) placement is relatively poor and highly heterogeneous; therefore, a prognostic scoring system is essential for survival prediction and risk stratification. Conventional scores include the Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) scores. The CTP score was created empirically and displayed a high correlation with post-TIPS survival. However, the inclusion of subjective parameters and the use of discrete cut-offs limit its utility. The advantages of the MELD score include its statistical validation and objective and readily available predictors that contribute to its broad application in clinical practice to predict post-TIPS outcomes. In addition, multiple modifications of the MELD score, by incorporating additional predictors (e.g., MELD-Sodium and MELD-Sarcopenia scores), adjusting coefficients (recalibrated MELD score), or combined (MELD 3.0), have been proposed to improve the prognostic ability of the standard MELD score. Despite several updates to conventional scores, a prognostic score has been proposed (based on contemporary data) specifically for outcome prediction after TIPS placement. However, this novel score (the Freiburg index of post-TIPS survival, FIPS) exhibited inconsistent discrimination in external validation studies, and its superiority over conventional scores remains undetermined. Additionally, several tools display potential for application in specific TIPS indications (e.g., bilirubin-platelet grade for refractory ascites), and biomarkers of systemic inflammation, nutritional status, liver disease progression, and cardiac decompensation may provide additional value, but require further validation. Future studies should consider the effect of TIPS placement when exploring predictors, as TIPS is a pathophysiological approach that substantially alters systemic hemodynamics and ameliorates bacterial translocation and malnutrition. K E Y W O R D S Child-Turcotte-Pugh (CTP) score, Freiburg index of post-TIPS survival (FIPS), model for endstage liver disease score (MELD), portal hypertension, prognosis, transjugular intrahepatic portosystemic shunt Key points • Multiple prognostic scores have been applied to predict post-transjugular intrahepatic portosystemic shunt (TIPS) survival, including conventional scores (e.g., Child-Turcotte-Pugh, a model for end-stage liver disease [MELD] and MELD-sodium scores) and scores based on contemporary data (e.g., MELD 3.0 and Freiburg index of post-TIPS survival score). • Novel prognostic biomarkers, especially those of systemic inflammation, nutritional status, liver disease severity, and cardiac decompensation could provide additional prognostic value for existing scoring systems.

show abstract

“…Two independent investigators screened the medical records, including demographic, endoscopic reports, laboratory results, and clinical data. Model for End-stage Liver Disease (MELD) score [16], the Glasgow-Blatchford score (GBS) [17], Child-Turcotte-Pugh score (CTP) [18] were calculated.…”

Section: Interventions and Data Collectionmentioning

confidence: 99%

The influences of timing of urgent endoscopy in patients with acute variceal bleeding: a cohort study

Yan

Leng

et al. 2022

BMC Gastroenterol

View full text Add to dashboard Cite

Background There has always been a debate on the optimal timing of endoscopy in patients with acute variceal bleeding (AVB). Objective This study aimed to examine the relation between the timing of endoscopy and the short-term outcomes of patients with AVB. Methods Patients with AVB who underwent endoscopy within 24 h after admission at our tertiary care center from 2014 to 2022 were evaluated retrospectively. The primary outcomes were the 6-week mortality and re-bleeding. The secondary outcomes included the total number of blood units transfused, the length of hospital stay, and the need for salvage therapy. We used Cox proportional hazards model to analyze the predictors of 6-week mortality in all patients as well as in those who were at high risk of further bleeding or death. Results A total of 312 patients were enrolled. Among them, 170 patients (54.49%) underwent urgent endoscopy (< 6 h), and 142 patients (45.51%) underwent early endoscopy (6–24 h). There were no significant differences between the urgent-endoscopy group and the early-endoscopy group, regarding the 6-week mortality (16.47% vs. 10.56%; P value = 0.132) and 6-week re-bleeding rate (11.2% vs. 16.2%; P value = 0.196). In multivariate analysis, time to endoscopy was independent of 6-week mortality (P value = 0.170), but the time between the beginning of bleeding and endoscopy (within 12 h) was significantly associated with low 6-week mortality (OR: 0.16; 95% CI: 0.06–0.46; P value = 0.001). Time to endoscopy was still not associated with 6-week mortality in patients at high risk for further bleeding or death (Glasgow-Blatchford score ≥ 12, n = 138, P value = 0.902). Conclusions Endoscopy performed within 6 h of admission, rather than within 6 to 24 h, did not improve six-week clinical outcomes in patients in stable condition with AVB and even those who were at high risk of further bleeding and death.

show abstract

Performance of the model for end-stage liver disease score for mortality prediction and the potential role of etiology

Cited by 17 publications

References 23 publications

Mortality after transjugular intrahepatic portosystemic shunt in older adult patients with cirrhosis: A validated prediction model

Mortality after transjugular intrahepatic portosystemic shunt in older adult patients with cirrhosis: A validated prediction model

A comprehensive review of prognostic scoring systems to predict survival after transjugular intrahepatic portosystemic shunt placement

The influences of timing of urgent endoscopy in patients with acute variceal bleeding: a cohort study

Contact Info

Product

Resources

About