Elective Liver Transplant List Mortality: Development of a United Kingdom End-Stage Liver Disease Score

Barber, Kerri; Madden, Susanna; Allen, Joanne B.; Collett, David; Neuberger, James; Gimson, Alexander

doi:10.1097/tp.0b013e318225db4d

Cited by 141 publications

(126 citation statements)

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“…However, we identified a subgroup of participants for whom the current weight-adjusted dose of UDCA was available (n 5 1,253). In this subgroup, the median dose of UDCA was 12 mg/kg/day (interquartile range [IQR]: [9][10][11][12][13][14]. This is lower than the recommended dose of UDCA (13-15 mg/kg/day), albeit comparable to the median dose reported by Lammers et al (13) in their study of 4,845 PBC patients from leading academic centers across the globe.…”

Section: Explanatory Variablesmentioning

confidence: 53%

“…1). (12) Furthermore, we selected the threshold, bilirubin 100 lmol/L, because bilirubin at this level is widely accepted to be an indication for LT, as reported in the EASL guidelines on the management of cholestatic liver diseases, 2009. (1) Participants who did not reach an event were censored at the date of their most recent blood tests or the date of non-liver-related death, if applicable.…”

Section: Study Entry and Outcomementioning

confidence: 99%

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The UK‐PBC risk scores: Derivation and validation of a scoring system for long‐term prediction of end‐stage liver disease in primary biliary cholangitis

et al. 2015

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; and the members of the UK-PBC Consortium*The biochemical response to ursodeoxycholic acid (UDCA)-so-called "treatment response"-strongly predicts long-term outcome in primary biliary cholangitis (PBC). Several long-term prognostic models based solely on the treatment response have been developed that are widely used to risk stratify PBC patients and guide their management. However, they do not take other prognostic variables into account, such as the stage of the liver disease. We sought to improve existing long-term prognostic models of PBC using data from the UK-PBC Research Cohort. We performed Cox's proportional hazards regression analysis of diverse explanatory variables in a derivation cohort of 1,916 UDCA-treated participants. We used nonautomatic backward selection to derive the best-fitting Cox model, from which we derived a multivariable fractional polynomial model. We combined linear predictors and baseline survivor functions in equations to score the risk of a liver transplant or liver-related death occurring within 5, 10, or 15 years. We validated these risk scores in an independent cohort of 1,249 UDCA-treated participants. The best-fitting model consisted of the baseline albumin and platelet count, as well as the bilirubin, transaminases, and alkaline phosphatase, after 12 months of UDCA. In the validation cohort, the 5-, 10-, and 15-year risk scores were highly accurate (areas under the curve: >0.90). Conclusions: The prognosis of PBC patients can be accurately evaluated using the UK-PBC risk scores. They may be used to identify high-risk patients for closer monitoring and second-line therapies, as well as low-risk patients who could potentially be followed up in primary care. (HEPATOLOGY 2016;63:930-950) SEE EDITORIAL ON PAGE 697 P rimary biliary cholangitis (PBC) is a chronic liver disease in which autoimmune destruction of the intrahepatic bile ducts results in cholestasis and progressive fibrosis.(1) Biliary injury may eventually lead to cirrhosis and liver failure-but the rate of disease progression is variable.(2) Across the spectrum, some patients with PBC progress to end-stage liver disease (ESLD) within a few years of diagnosis; some develop cirrhosis that remains well compensated; others (perhaps the majority) do not even develop cirrhosis. In PBC, as in other conditions, accurate prognostication enables management of the disease to be tailored to the patient. This is the basis of precision medicine-and it has clear benefits: patients at higherAbbreviations: AIH, autoimmune hepatitis; ALP, alkaline phosphatase; ALP12, alkaline phosphatase after 12 months of UDCA; AMA, anti-mitochondrial antibody; ANA, anti-nuclear antibodies; ALT, alanine aminotransferase; ALT12, ALT after 12 months of UDCA; AST, aspartate transaminase; AST12, AST after 12 months of UDCA; AUC, area under receiver operating characteristic curve; BIL, bilirubin; BIL12, bilirubin after 12 months of UDCA; CI, confidence interval; CRFs, case record forms; EASL, European Association for the Study of Liver; ESLD, end-stag...

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Section: Explanatory Variablesmentioning

confidence: 53%

Section: Study Entry and Outcomementioning

confidence: 99%

The UK‐PBC risk scores: Derivation and validation of a scoring system for long‐term prediction of end‐stage liver disease in primary biliary cholangitis

et al. 2015

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“…Updated MELD (assigning lower weight to creatinine and INR while higher weight to bilirubin based on SRTR analysis of 38,899 patients transplanted between 2001-2006), 130 refit MELD (reassigning lower and upper limits of 0.8 and 3.0 for serum creatinine while 1 and 3 for INR respectively), 128 integrated MELD including sodium and age, 93 MESO (ratio of MELD to serum sodium), MeldNa (incorporating serum sodium for levels between 125 and 140 mmol/L), 124 UK end stage liver disease score (UKELD) which is similar to MELD-Na and is used for listing patients for liver transplantation in the UK, 131 and ReFit MELD-Na as for refit MELD but including serum sodium also 128 are some of the refinements, which have been tried to improve the accuracy of the MELD score. In one study, comparing these models, UKELD and updated MELD were poor in predicting mortality compared to other 4 models.…”

Section: Other Suggested Modificationsmentioning

confidence: 99%

Model for End-stage Liver Disease

Singal

Kamath

2013

Journal of Clinical and Experimental Hepatology

132

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“…Child-Turcotte-Pugh (CTP) score, model for end-stage liver disease (MELD), acute physiology and chronic health evaluation II (APACHE II) score and sepsis-associated organ failure assessment (SOFA) score were calculated according to the Pugh modification [8], United Network of Organ Sharing adjustments [9], Knaus et al [10] Vincent et al [11].…”

Section: Exclusion Criteriamentioning

confidence: 99%

Scoring Systems and Risk Stratification in Cirrhotic Patients with Acute Variceal Bleeding "Scoring in Variceal Bleeding"

Mohammad¹,

Morsy²

2016

J Liver

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Objectives: To find the most accurate, suitable and applicable scoring system used for prediction of outcome in cirrhotic patients with bleeding varices. Methods:This prospective study included 120 cirrhotic patients with acute variceal bleeding, admitted at Department of Tropical Medicine and Gastroenterology in Sohag University Hospital over a one-year period (1/2015 to 1/2016). Clinical, laboratory and endoscopic parameters were studied, Child-Pugh (CTP) classification score, Model for end-stage liver disease (MELD) score, Acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score and AIMS65 score were calculated for all patients, univariate, multivariate analysis and performance was performed for all taken parameters and the scores. Results:The 120 patients (92 male, 28 female) admitted during the study period, eight patients (6.67%) died in hospital. Higher age, presence of encephalopathy, rebleeding, and higher serum bilirubin were independent factors associated with higher hospital mortality. The largest area under the receiver operator curve (AUROC) was for AIMS65 score and SOFA score followed by MELD score and APACHEII score then Child score all of which achieved very good performance (AUROC > 0.8). AIMS 65 score has the best sensitivity, specificity negative and positive predictive values. Although AIMS65 score was not significantly different from MELD, SOFA, and APACHEII scores, it was the best among them in prediction of mortality.Conclusions: AIMS65 score is best simple and applicable scoring system to independently predict mortality in those patients.

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Elective Liver Transplant List Mortality: Development of a United Kingdom End-Stage Liver Disease Score

Abstract: This model, developed specifically for patients awaiting liver transplantation, provides a useful tool for the selection of patients for liver transplantation and the allocation of donor livers.

Cited by 141 publications

References 26 publications

The UK‐PBC risk scores: Derivation and validation of a scoring system for long‐term prediction of end‐stage liver disease in primary biliary cholangitis

The UK‐PBC risk scores: Derivation and validation of a scoring system for long‐term prediction of end‐stage liver disease in primary biliary cholangitis

Model for End-stage Liver Disease

Scoring Systems and Risk Stratification in Cirrhotic Patients with Acute Variceal Bleeding "Scoring in Variceal Bleeding"

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