Model for end-stage liver disease score and MELD exceptions: 15 years later

Asrani, Sumeet K.; Kamath, Patrick S.

doi:10.1007/s12072-015-9631-3

Cited by 54 publications

(47 citation statements)

References 84 publications

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“…Model for End-stage Liver Disease is the most common predictor for prognosis evaluating of ACLF. 18 CLIF-C ACLFs, considering multi-organ failure and inflammation level, is a newly developed prognostic parameter for ACLF with improved predictive accuracy. 11 It was investigated the correlation between NMI and prognostic scores of HBV-ACLF.…”

Section: Correlation Between Serum N-myc and Stat Interactor And Clinmentioning

confidence: 99%

N‐myc and STAT interactor correlates with severity and prognosis in acute‐on‐chronic liver failure of hepatitis B virus

Xiong

Zhou

et al. 2019

J of Gastro and Hepatol

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Background and Aim Hepatitis B virus‐related acute‐on‐chronic liver failure (HBV‐ACLF) is characterized by acute deterioration of chronic liver disease with excessive inflammation. N‐myc and STAT interactor (NMI), an inflammation‐mediated protein, involves in various inflammatory‐related diseases, but the role of NMI in development and prognosis in HBV‐ACLF remains to be elucidated. Methods Serum NMI from healthy controls (HCs, n = 20), chronic hepatitis B (CHB, n = 50) patients, and HBV‐ACLF patients (n = 50) was determined using ELISA. NMI from peripheral blood mononuclear cells and liver was confirmed using quantitative real‐time polymerase chain reaction, Western blot, and immunofluorescence. Results Serum NMI was increased 1.9‐fold or 2.2‐fold from HBV‐ACLF patients compared with that from HCs (P < 0.01) or CHB patients (P < 0.01). Consistently, NMI from peripheral blood mononuclear cells was upregulated significantly from HBV‐ACLF patients compared with that from HCs and CHB patients at mRNA and protein levels. Hepatic NMI from HBV‐ACLF patients was 2.8‐fold higher than that from HCs. Serum NMI was correlated with Model for End‐stage Liver Disease, Chronic Liver Failure Consortium ACLF score, and ACLF grades. In contrast, serum NMI was significantly decreased in HBV‐ACLF ameliorated patients during follow‐up, whereas serum NMI was sustained at high levels in non‐ameliorated patients. Elevated serum NMI (≥ 198.5 pg/mL) was correlated with poor survival rate of HBV‐ACLF patients. Using receiver operating characteristics curves, it was suggested that serum NMI was a potential biomarker in predicting 3‐month mortality of HBV‐ACLF patients. Conclusions Our study highlights the potential role of NMI in assessing the development and prognosis of HBV‐ACLF.

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Section: Correlation Between Serum N-myc and Stat Interactor And Clinmentioning

confidence: 99%

N‐myc and STAT interactor correlates with severity and prognosis in acute‐on‐chronic liver failure of hepatitis B virus

Xiong

Zhou

et al. 2019

J of Gastro and Hepatol

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“…The Model for End‐Stage Liver Disease (MELD)–based prioritization system is based on urgency, which prioritizes the sickest patient with the greatest need for liver transplantation and the highest wait‐list mortality. Since its introduction in 2002, the MELD‐based system has been successful in reducing wait‐list mortality . Furthermore, it achieves this goal by using only simple, objective, readily available, and inexpensive laboratory tests, although other factors such as liver disease etiology can also potentially affect wait‐list mortality .…”

Section: Urgency: the Current Model For End‐stage Liver Disease–basedmentioning

confidence: 99%

“…Since its introduction in 2002, the MELD-based system has been successful in reducing wait-list mortality. (11) Furthermore, it achieves this goal by using only simple, objective, readily available, and inexpensive laboratory tests, although other factors such as liver disease etiology can also potentially affect wait-list mortality. (12) The downside of all urgency-based systems, including the MELD-based system, is that they do not consider posttransplantation survival.…”

Section: Urgency: the Current Model For End-stage Liver Disease-basedmentioning

confidence: 99%

Transplant‐related survival benefit should influence prioritization for liver transplantation especially in patients with hepatocellular carcinoma

Ioannou

2017

Liver Transpl

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Transplant-related survival benefit is calculated as the difference between life expectancy with transplantation and life expectancy without transplantation. Determining eligibility and prioritization for liver transplantation based on the highest survival benefit is a superior strategy to prioritization based on the highest urgency (ie, the highest wait-list mortality) or the highest utility (ie, the highest posttransplant survival) because prioritization based on the highest survival benefit maximizes the overall life expectancy of all patients in need of liver transplantation. Although the Model for End-Stage Liver Disease (MELD)-based prioritization system was designed as an urgency-based system, in practice it functions to a large extent as a survival benefit-based system, when the natural MELD score is used without exceptions. Survival benefit considerations should be used to determine the consequences of deviating from prioritization based on the natural MELD score, such as when exception points are awarded to patients with hepatocellular carcinoma (HCC) that are independent of MELD score or tumor burden, or the appropriateness of expanding eligibility for transplantation. The most promising application of survival benefit-based prioritization would be to replace the current system of prioritization of patients with HCC by one that uses their natural MELD score and tumor characteristics such as HCC tumor burden, serum alpha fetoprotein level, and response to locoregional therapies to predict the impact on survival benefit caused by the presence of HCC and adjust the natural MELD score for prioritization accordingly. Liver Transplantation 23 652-662, 2017 AASLD.

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“…3,4 Crucially, antiviral treatments are reducing viral liver disease, permitting non-alcoholic fatty and alcoholic liver disease, including alcoholic hepatitis in recent years, to emerge as the leading indications for listing. 3,4 Crucially, antiviral treatments are reducing viral liver disease, permitting non-alcoholic fatty and alcoholic liver disease, including alcoholic hepatitis in recent years, to emerge as the leading indications for listing.…”

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confidence: 99%

The decreasing predictive power of MELD in an era of changing etiology of liver disease

Godfrey

Malik

Lai

et al. 2019

American Journal of Transplantation

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The field of liver transplantation has shifted considerably in the MELD era, including changing allocation, immunosuppression, and liver failure etiologies, as well as better supportive therapies. Our aim was to evaluate the predictive accuracy of the MELD score over time. The United Network for Organ Sharing provided de‐identified data on 120 156 patients listed for liver transplant from 2002‐2016. The ability of the MELD score to predict 90‐day mortality was evaluated by a concordance (C‐) statistic and corroborated with competing risk analysis. The MELD score's concordance with 90‐day mortality has downtrended from 0.80 in 2003 to 0.70 in 2015. While lab MELD scores at listing and transplant climbed in that interval, score at waitlist death remained steady near 35. Listing age increased from 50 to 54 years. HCV‐positive status at listing dropped from 33 to 17%. The concordance of MELD and mortality does not differ with age (>60 = 0.73, <60 = 0.74), but is lower in diseases that are increasing most rapidly—alcoholic liver disease and non‐alcoholic fatty liver disease—and higher in those that are declining, particularly in HCV‐positive patients (HCV positive = 0.77; negative = 0.73). While MELD still predicts mortality, its accuracy has decreased; changing etiology of disease may contribute.

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Model for end-stage liver disease score and MELD exceptions: 15 years later

Cited by 54 publications

References 84 publications

N‐myc and STAT interactor correlates with severity and prognosis in acute‐on‐chronic liver failure of hepatitis B virus

N‐myc and STAT interactor correlates with severity and prognosis in acute‐on‐chronic liver failure of hepatitis B virus

Transplant‐related survival benefit should influence prioritization for liver transplantation especially in patients with hepatocellular carcinoma

The decreasing predictive power of MELD in an era of changing etiology of liver disease

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