Scoring system for predicting 90-day mortality of in-hospital liver cirrhosis patients at Cipto Mangunkusumo Hospital

Abstract

Background Liver cirrhosis is the final stage of chronic liver disease. Complications due to progression of liver disease may deteriorate the liver function and worsen prognosis. Previous studies have shown that patients with liver cirrhosis are at increased risk of death within 90-day after hospitalization. It is necessary to identify patients who are at higher risk of early mortality. This study aims to develop a scoring system to predict the 90-day mortality among hospitalized patients with liver cirrhosis that could be used for modification of treatment plan according to the scores that have been obtained. By using this scoring system, crucial care of plans can be taken to reduce the risk of mortality. Method This prospective cohort study was conducted on hospitalized cirrhotic patients at Cipto Mangunkusumo National General Hospital, Jakarta. Demographic, clinical, and laboratory data were recorded. Patients were monitored for up to 90-day after hospitalization to determine their condition. Cox regression analysis was performed to obtain predictor factors contributing to mortality in liver cirrhosis patients. The scoring system that resulted from this study categorized patients into low, moderate, and high-risk categories based on their predicted mortality rates. The sensitivity and specificity of the scoring system were evaluated using the AUC (area under the curve) metric. Result The study revealed that liver cirrhosis patients who were hospitalized had a 90-day mortality rate of 42.2%, with contributing factors including Child-Pugh, MELD, and leukocyte levels. The combination of these variables had a good discriminative value with an AUC of 0.921 (95% CI: 0.876–0.967). The scoring system resulted in three risk categories: low risk (score of 0–3) with a 4.1-18.4% probability of death, moderate risk (score of 5–6) with a 40.5-54.2% probability of death, and high risk (score of 8–11) with a 78.1-94.9% probability of death. Conclusion The scoring system has shown great accuracy in predicting 90-day mortality in hospitalized cirrhosis patients, making it a valuable tool for identifying the necessary care and interventions needed for these patients upon admission.

Navigating Cirrhosis: A Comprehensive Review of Liver Scoring Systems for Diagnosis and Prognosis

“…The significance of liver scoring systems in facilitating early diagnosis and predicting mortality in decompensated liver cirrhosis cannot be overstated. Various scoring systems, including the Child-Turcotte-Pugh (CTP) score, model for end-stage liver disease (MELD) score, MELD-Na, and MELD to serum sodium ratio (MESO), have been instrumental in assessing the severity of liver disease and forecasting prognosis [ 8 , 9 ]. By leveraging these scoring systems, clinicians can make more accurate diagnoses, tailor treatment strategies effectively, and ultimately improve patient outcomes.…”

“…Furthermore, it is crucial to recognize that liver scoring systems should complement rather than replace clinical judgment. Therefore, further research efforts, including multicenter studies with larger sample sizes and long-term follow-ups, are warranted to enhance the accuracy and reliability of these scoring systems [ 8 , 9 ]. While liver scoring systems play a critical role in predicting mortality in liver cirrhosis, continual refinement and improvement are necessary to maximize their effectiveness in early diagnosis and prognosis assessment.…”

“…Components and calculation: The MELD score is a crucial tool for assessing the severity of liver disease and predicting mortality in patients with cirrhosis [ 17 ]. Computed using serum bilirubin, serum creatinine, and international normalized ratio (INR), the MELD score ranges from six to 40, with higher scores indicating more severe liver disease [ 9 , 17 ]. Calculation of the MELD score involves a specific formula: MELD(i)=round1 (0.378*loge(bilirubin))+(1.120loge(INR))+(0.957loge(creatinine))+0.643 1 rounded to the tenth decimal place.…”

“…The maximum MELD score attainable is 40 [ 17 ]. While the MELD score is effective in predicting mortality in liver cirrhosis patients, it may have prognostic errors in predicting death due to extrahepatic organ dysfunction [ 9 ]. Additionally, other general scoring systems such as Acute Physiology and Chronic Health Evaluation (APACHE) II and III, Sequential Organ Failure Assessment (SOFA), Multiple Organ Dysfunction Score (MODS), and RIFLE (Risk, Injury, Failure, Loss And End-Stage Renal Failure) can be utilized in hospitalized cirrhosis patients [ 9 ].…”

“…However, specific sensitivity and specificity values were not provided [ 8 ]. Moreover, a scoring system aimed at predicting 90-day mortality in in-hospital liver cirrhosis patients yielded a sensitivity of 81.3% and specificity of 50.9% for predicting 28-day mortality through a combination of three variables [ 9 ]. Additionally, research on HCC highlighted the HCC-ART score as effective for early diagnosis, boasting a sensitivity of 97% and a specificity of 96% [ 37 ].…”