Updates on the Model for End-Stage Liver Disease Score and Impact on the Liver Transplant Waiting List: A Narrative Review

Molano, Maria del Pilar Bayona; Gutierrez, Juan Carlos Barrera; Landinez, Gina; Mejía, Alejandro; Haskal, Ziv J.

doi:10.1016/j.jvir.2022.12.029

Cited by 6 publications

(3 citation statements)

References 38 publications

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“…The severity of liver dysfunction is often estimated using the MELD score or CTP classification. MELD is a continuous score derived from the calculation of serum creatinine and bilirubin levels and the international normalized PT ratio ( 55 – 57 ). However, MELD has been widely adopted for end-stage cirrhotic patients awaiting liver transplantation ( 2 ) and is specifically designed for patients with end-stage cirrhosis ( 58 – 60 ).…”

Section: Discussionmentioning

confidence: 99%

Association of easy albumin-bilirubin score with increased mortality in adult trauma patients

Hsu,

Rau,

Tsai

et al. 2024

Front. Surg.

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IntroductionThe easy albumin-bilirubin (EZ-ALBI) score is calculated using the equation: total bilirubin (mg/dl) − 9 × albumin (g/dl), and is used to evaluate liver functional reserve. This study was designed to investigate whether the EZ-ALBI score serves as an independent risk factor for mortality and is useful for stratifying the mortality risk in adult trauma patients.MethodsWe retrospectively reviewed data from the registered trauma database of the hospital and included 3,637 adult trauma patients (1,241 deaths and 2,396 survivors) due to all trauma caused between January 1, 2009, and December 31, 2021. The patients were allocated to the two study groups based on the best EZ-ALBI cutoff point (EZ-ALBI = −28.5), which was determined based on the area under the receiver operating characteristic curve.ResultsResults revealed that the non-survivors had a significantly higher EZ-ALBI score than the survivors (−26.4 ± 6.5 vs. −31.5 ± 6.2, p < 0.001). Multivariate logistic regression analysis revealed that EZ-ALBI ≥ −28.5was an independent risk factor for mortality (odds ratio, 2.31; 95% confidence interval, 1.63–3.28; p < 0.001). Patients with an EZ-ALBI score ≥ −28.5 presented with 2.47-fold higher adjusted mortality rates than patients with an EZ-ALBI score < −28.5. A propensity score-matched pair cohort of 1,236 patients was developed to reduce baseline disparities in trauma mechanisms. The analysis showed that patients with an EZ-ALBI score ≥ −28.5 had a 4.12 times higher mortality rate compared to patients with an EZ-ALBI score < −28.5.ConclusionThe EZ-ALBI score was a significant independent risk factor for mortality and can serve as a valuable tool for stratifying mortality risk in adult trauma patients by all trauma causes.

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Section: Discussionmentioning

confidence: 99%

Association of easy albumin-bilirubin score with increased mortality in adult trauma patients

Hsu,

Rau,

Tsai

et al. 2024

Front. Surg.

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“…The CTP classification is primarily designed to assess cirrhosis, which limits its applicability to other liver diseases; there were over 30 variations in the CTP categorization, thus causing errors in scoring [65]. The MELD score, on the other hand, is a continuous value generated from the levels of serum creatinine, bilirubin, and the international normalized PT ratio [66][67][68]. The use of the MELD score in patients with milder liver impairment has drawn criticism [5]; it was primarily created for end-stage cirrhosis patients or those awaiting liver transplantation [69][70][71].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Easy Albumin–Bilirubin Score as a Prognostic Tool for Mortality in Adult Trauma Patients in the Intensive Care Unit: A Retrospective Study

Kuo,

Rau,

Tsai

et al. 2023

Diagnostics

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The easy albumin–bilirubin (EZ–ALBI) score is derived using the following equation: total bilirubin (mg/dL) − 9 × albumin (g/dL). This study aimed to determine whether the EZ–ALBI score predicted mortality risk in adult trauma patients in an intensive care unit (ICU). Data from a hospital’s trauma database were retrospectively evaluated for 1083 adult trauma ICU patients (139 deaths and 944 survivors) between 1 January 2016 and 31 December 2021. Patients were classified based on the ideal EZ–ALBI cut-off of −26.5, which was determined via receiver operating characteristic curve analysis. The deceased patients’ EZ–ALBI scores were higher than those of the surviving patients (−26.8 ± 6.5 vs. −30.3 ± 5.9, p = 0.001). Multivariate logistic analysis revealed that, in addition to age, the presence of end-stage renal disease, Glasgow Coma Scale scores, and injury severity scores, the EZ–ALBI score is an independent risk factor for mortality (odds ratio (OR), 1.10; 95% confidence interval (CI): 1.06–1.14; p = 0.001)). Compared with patients with EZ–ALBI scores < −26.5, those with scores ≥ −26.5 had a 2.1-fold higher adjusted mortality rate (adjusted OR, 2.14; 95% CI: 1.43–3.19, p = 0.001). In conclusion, the EZ–ALBI score is a substantial and independent predictor of mortality and can be screened to stratify mortality risk in adult trauma ICU patients.

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“…While MELD and its derivations reliably predict waitlist mortality (C-statistic of 0.78-0.91), 9,17 they fail to forecast post-LT risk of death or severe complications (C-statistic of 0.44-0.58). [18][19][20][21] This makes MELD a poor measure for assessing risk of "futile" transplantation.…”

Section: Introductionmentioning

confidence: 99%

Development and Internal Validation of a Novel Pre-Transplant Biomarker Panel to Predict Post-Liver Transplant Mortality

Panayotova,

Simonishvili,

Nguyen

et al. 2023

Preprint

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Current scoring systems accurately predict risk of pre-liver transplant (LT) mortality but fall short in estimation of post-LT survival. This study seeks to identify biomarkers of pre-LT immune dysfunction that predict mortality following LT. From 10/1/13-3/23/21, 279 cirrhotic patients underwent assessment of plasma biomarker (Luminex) and clinical variables immediately prior to LT (T0). Cox-proportional hazards modeling identified HCV IgG, Fractalkine, and MMP3 as multivariate predictors of 1-year mortality, with covariate selection by clinical importance and LASSO methodology. These were utilized to comprise the novel Liver Immune Frailty Index (LIFI), which stratifies recipients into -low, -moderate, and –high risk tertiles. One-year mortality was 1.4%, 12.7%, and 58.3% for LIFI-low, -moderate, and -high, respectively. Internal validation through bootstrap resampling with 2000 replicates demonstrates LIFI predicts early post-LT mortality with C-statistic=0.84 and Brier score of 0.04. LIFI may identify patients at risk for persistent severe immune dysfunction and early mortality following LT.

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Updates on the Model for End-Stage Liver Disease Score and Impact on the Liver Transplant Waiting List: A Narrative Review

Cited by 6 publications

References 38 publications

Association of easy albumin-bilirubin score with increased mortality in adult trauma patients

Association of easy albumin-bilirubin score with increased mortality in adult trauma patients

Evaluation of the Easy Albumin–Bilirubin Score as a Prognostic Tool for Mortality in Adult Trauma Patients in the Intensive Care Unit: A Retrospective Study

Development and Internal Validation of a Novel Pre-Transplant Biomarker Panel to Predict Post-Liver Transplant Mortality

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