Predicting 1-year mortality among patients with decompensated cirrhosis: results of a multicentre evaluation of the Bristol Prognostic Score

Abstract

ObjectiveChronic liver disease continues to be a significant cause of morbidity and mortality yet remains challenging to prognosticate. This has been one of the barriers to implementing palliative care, particularly at an early stage. The Bristol Prognostic Score (BPS) was developed to identify patients with life expectancy less than 12 months and to act as a trigger for referral to palliative care services. This study retrospectively evaluated the BPS in a cohort of patients admitted to three Scottish hospitals.MethodRoutinely collated healthcare data were used to obtain demographics, BPS and analyse 1-year mortality for patients with decompensated liver disease admitted to three gastroenterology units over two 90-day periods. Statistical analysis was undertaken to assess performance of BPS in predicting mortality.Results276 patients were included in the final analysis. Participants tended to be late middle-aged men, socioeconomically deprived and have alcohol-related liver disease. A similar proportion was BPS+ve (>3) in this study compared with the original Bristol cohort though had more hospital admissions, higher ongoing alcohol use and poorer performance status. BPS performed poorer in this non-Bristol group with sensitivity 54.9% (72.2% in original study), specificity 58% (83.8%) and positive predictive value (PPV) 43.4% (81.3%).ConclusionBPS was unable to accurately predict mortality in this Scottish cohort. This highlights the ongoing challenge of prognostication in patients with chronic liver disease, furthering the call for more work in this field.

Knowledge, Attitudes and Practices Towards Psoriasis Among Patients and Their Family Members

“…Healthcare practitioners should concentrate on refining the lines of communication between patients and doctors to effectively address concerns and rectify misconceptions surrounding various treatments. 26 , 27 Moreover, the inclusion of family members in the treatment regimen can wield a positive influence on patient adherence. This inclusion might encompass educating family members on the significance of treatment adherence, accentuating their supportive role, and cultivating an environment conducive to sustained compliance.…”

Improving palliative and supportive care in advanced cirrhosis: the HepatoCare model of integrated collaborative care

“…The Bristol Prognostic Score was specifically developed to identify patients with decompensated cirrhosis at high risk of 1-year mortality, but a validation study found it has suboptimal sensitivity. 27 Standardised criteria based on patient characteristics (CTP 'C' status, multiple short-term liver-related admissions, current alcohol use in alcohol-related cirrhosis, unsuitability for transplantation and poor performance status) have been shown to predict high 1-year mortality, 28 but implementation of these criteria was only associated with a modest (33%) uptake of referral to PC. 29 Tandon et al 30 employed a functional assessment score (MELD + age + Karnovsky Performance Status) but it is arguable that our HepatoCare referral criteria are more intuitive for those experienced in the care of patients with cirrhosis.…”

“…Newer scores and criteria have been developed in this area but they are variably effective. The Bristol Prognostic Score was specifically developed to identify patients with decompensated cirrhosis at high risk of 1‐year mortality, but a validation study found it has suboptimal sensitivity 27 . Standardised criteria based on patient characteristics (CTP ‘C’ status, multiple short‐term liver‐related admissions, current alcohol use in alcohol‐related cirrhosis, unsuitability for transplantation and poor performance status) have been shown to predict high 1‐year mortality, 28 but implementation of these criteria was only associated with a modest (33%) uptake of referral to PC 29 .…”