Comparison of APACHE IV with APACHE II, SAPS 3, MELD, MELD-Na, and CTP scores in predicting mortality after liver transplantation

Abstract

The Acute Physiology and Chronic Health Evaluation (APACHE) IV score and Simplified Acute Physiology Score (SAPS) 3 include liver transplantation as a diagnostic category. The performance of APACHE IV-liver transplantation (LT) specific predicted mortality, SAPS 3, APACHE II, Model for End-stage Liver Disease (MELD)-Na, MELD, and CTP scores in predicting in-hospital and 1 year mortality in liver transplant patients was compared using 590 liver transplantations in a single university hospital. In-hospital mortality and 1 year mortality were 2.9% and 4.2%, respectively. The APACHE IV-LT specific predicted mortality showed better performance in predicting in-hospital mortality (AUC 0.91, 95% CI [0.86–0.96]) compared to SAPS 3 (AUC 0.78, 95% CI [0.66–0.90], p = 0.01), MELD-Na (AUC 0.74, 95% CI [0.57–0.86], p = 0.01), and CTP (AUC 0.68, 95% CI [0.54–0.81], p = 0.01). The APACHE IV-LT specific predicted mortality showed better performance in predicting 1 year mortality (AUC 0.83, 95% CI [0.76–0.9]) compared to MELD-Na (AUC 0.67, 95% CI [0.55–0.79], p = 0.04) and CTP (AUC 0.64, 95% CI [0.53–0.75], p = 0.03), and also in all MELD groups and in both living and deceased donor transplantation. The APACHE IV-LT specific predicted mortality showed better performance in predicting in-hospital and 1 year mortality after liver transplantation.

Analysis of mortality prognostic factors using model for end-stage liver disease with incorporation of serum-sodium classification for liver cirrhosis complications

“…[12] The cut-off point of MELD-Na for this study was 14, relatively lower than that of other studies. [13,24] While most of the previous studies focused on patients in end-stage cirrhosis or admitted to the intensive care unit and scheduled for liver transplantation, this study focused on patients diagnosed with cirrhosis complications that could be treated in general wards, for the first time, so there would be a difference in terms of severity. Compared with previous studies, this study addressed patients with relatively low mortality rates, less severe conditions, and longer average survival period, but it would be necessary to expand the scope of participants to raise the use of the cut-off point of MELD-Na.…”

Is Muscle MELD a More Promising Predictor for Mortality After Living Donor Liver Transplantation?

“…The D-MELD is the product of donor age and MELD score, MELD Na was calculated according to Kim et al formula 4 : MELD Na = MELD – Na – (0.025 × MELD × [140-Na]) + 140 with maximum and minimum serum Na of 140 and 125 mmol/L, respectively, and integrated MELD was computed according to this equation: iMELD = MELD + (age [years] × 0.3) – (0.7 × Na [mmol/L]) + 100. 5,6,7…”

“…The D-MELD is the product of donor age and MELD score, MELD Na was calculated according to Kim et al formula 4 : MELD Na ¼ MELD -Na -(0.025 Â MELD Â [140-Na]) þ 140 with maximum and minimum serum Na of 140 and 125 mmol/L, respectively, and integrated MELD was computed according to this equation: 5,6,7 The BAR score includes 6 variables that are the recipient and donor ages (years), cold ischemia time (h), retransplantation (yes/no), days in intensive care unit (ICU) with mechanical ventilation before transplant, and MELD score. It was calculated using an online score calculator and as described by Dutkowski et al 3,13…”

“…In addition, the balance of risk (BAR) score, developed by Dutkowski et al, 3 was based on the analysis of the United Network for Organ Sharing database and University Hospital Zurich database incorporating 5 recipient and donor variables along with the MELD score to obtain a mortality risk score. [3][4][5][6][7][8] In our institution, we previously proposed Muscle-MELD score (M-MELD) that incorporated preoperative muscularity into the MELD to accurately predict mortality posttransplant. 9 So, in the present study, we evaluated the performance of these different scores for prediction of patient mortality after LDLT and compared them with the MELD score.…”

“…In addition, the balance of risk (BAR) score, developed by Dutkowski et al, 3 was based on the analysis of the United Network for Organ Sharing database and University Hospital Zurich database incorporating 5 recipient and donor variables along with the MELD score to obtain a mortality risk score. 3 –8…”