TY - JOUR
T1 - A model to predict survival in patients with end-stage liver disease
AU - Kamath, Patrick S.
AU - Wiesner, Russell H.
AU - Malinchoc, Michael
AU - Kremers, Walter
AU - Therneau, Terry M.
AU - Kosberg, Catherine L.
AU - D’amico, Gennaro
AU - Dickson, E. Rolland
AU - Kim, W. Ray
N1 - Funding Information:
Abbreviations: IOM, Institute of Medicine; CTP, Child-Turcotte-Pugh; MELD, Model for End-Stage Liver Disease; TIPS, transjugular intrahepatic portosystemic shunt; PBC, primary biliary cirrhosis; INR, International Normalized Ratio; CI, confidence interval; SBP, spontaneous bacterial peritonitis; ISI, International Sensitivity Index. From the 1Division of Gastroenterology and Hepatology, and the 2Department of Health Science Research, Mayo Clinic and Foundation, Rochester, MN; and the 3Divi-sione di Medicina, Ospedale V Cervello, Palermo, Italy. Received November 13, 2000; accepted December 10, 2000. Supported by a grant from the National Institutes of Health (DK-34238). The data presented in this manuscript have been presented and discussed at the OPTN/UNOS Liver and Intestinal Organ Transplantation Committee. Address reprint requests to: W. Ray Kim, M.D., M.B.A., Gastroenterology and Hepatology (Ch10), Mayo Clinic and Foundation, 200 First Street, SW, Rochester, MN 55905. E-mail: kim.woong@mayo.edu; fax: 507-266-2810. Copyright © 2001 by the American Association for the Study of Liver Diseases. 0270-9139/01/3302-0021$35.00/0 doi:10.1053/jhep.2001.22172
PY - 2001
Y1 - 2001
N2 - A recent mandate emphasizes severity of liver disease to determine priorities in allocating organs for liver transplantation and necessitates a disease severity index based on generalizable, verifiable, and easily obtained variables. The aim of the study was to examine the generalizability of a model previously created to estimate survival of patients undergoing the transjugular intrahepatic portosystemic shunt (TIPS) procedure in patient groups with a broader range of disease severity and etiology. The Model for End-Stage Liver Disease (MELD) consists of serum bilirubin and creatinine levels, International Normalized Ratio (INR) for prothrombin time, and etiology of liver disease. The model's validity was tested in 4 independent data sets, including (1) patients hospitalized for hepatic decompensation (referred to as "hospitalized" patients), (2) ambulatory patients with noncholestatic cirrhosis, (3) patients with primary biliary cirrhosis (PBC), and (4) unselected patients from the 1980s with cirrhosis (referred to as "historical" patients). In these patients, the model's ability to classify patients according to their risk of death was examined using the concordance (c)-statistic. The MELD scale performed well in predicting death within 3 months with a c-statistic of (1) 0.87 for hospitalized patients, (2) 0.80 for noncholestatic ambulatory patients, (3) 0.87 for PBC patients, and (4) 0.78 for historical cirrhotic patients. Individual complications of portal hypertension had minimal impact on the model's prediction (range of improvement in c-statistic: <.01 for spontaneous bacterial peritonitis and variceal hemorrhage to ascites: 0.01-0.03). The MELD scale is a reliable measure of mortality risk in patients with end-stage liver disease and suitable for use as a disease severity index to determine organ allocation priorities.
AB - A recent mandate emphasizes severity of liver disease to determine priorities in allocating organs for liver transplantation and necessitates a disease severity index based on generalizable, verifiable, and easily obtained variables. The aim of the study was to examine the generalizability of a model previously created to estimate survival of patients undergoing the transjugular intrahepatic portosystemic shunt (TIPS) procedure in patient groups with a broader range of disease severity and etiology. The Model for End-Stage Liver Disease (MELD) consists of serum bilirubin and creatinine levels, International Normalized Ratio (INR) for prothrombin time, and etiology of liver disease. The model's validity was tested in 4 independent data sets, including (1) patients hospitalized for hepatic decompensation (referred to as "hospitalized" patients), (2) ambulatory patients with noncholestatic cirrhosis, (3) patients with primary biliary cirrhosis (PBC), and (4) unselected patients from the 1980s with cirrhosis (referred to as "historical" patients). In these patients, the model's ability to classify patients according to their risk of death was examined using the concordance (c)-statistic. The MELD scale performed well in predicting death within 3 months with a c-statistic of (1) 0.87 for hospitalized patients, (2) 0.80 for noncholestatic ambulatory patients, (3) 0.87 for PBC patients, and (4) 0.78 for historical cirrhotic patients. Individual complications of portal hypertension had minimal impact on the model's prediction (range of improvement in c-statistic: <.01 for spontaneous bacterial peritonitis and variceal hemorrhage to ascites: 0.01-0.03). The MELD scale is a reliable measure of mortality risk in patients with end-stage liver disease and suitable for use as a disease severity index to determine organ allocation priorities.
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U2 - 10.1053/jhep.2001.22172
DO - 10.1053/jhep.2001.22172
M3 - Article
C2 - 11172350
AN - SCOPUS:0035146422
SN - 0270-9139
VL - 33
SP - 464
EP - 470
JO - Hepatology
JF - Hepatology
IS - 2
ER -