Validation of a Model for Identification of Patients With Compensated Cirrhosis at High Risk of Decompensation

Guha, Indra Neil; Harris, Rebecca; Berhane, Sarah; Dillon, Audrey; Coffey, Lisa; James, Martin; Cucchetti, Alessandro; Harman, D. J.; Aithal, Guruprasad P.; Elshaarawy, Omar; Waked, Imam; Stewart, Stephen; Johnson, Philip J.

doi:10.1016/j.cgh.2019.01.042

Cited by 42 publications

(47 citation statements)

References 27 publications

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“…Moreover, a recent, prospective study validated the ALBI score as a measure of liver dysfunction in patients with compensated cirrhosis and proposed a new score, ALBI-FIB4, to stratify these patients for the risk of future liver decompensation [23]. In addition, the ALBI score has been found to significantly predict portal hypertension (both clinically significant and severe) [22].…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of ALBI, MELD, and Child-Pugh scores in prognosis of cirrhosis: is ALBI the new alternative?

Fragaki

Sifaki-Pistolla

Orfanoudaki

2019

aog

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Background The existence of reliable prognostic indices is of paramount importance in the management of cirrhosis. Both the model for end-stage liver disease (MELD) score and the older Child-Pugh (CP) scores are widely used. The albumin-bilirubin (ALBI) score, initially used in hepatocellular carcinoma, has not been thoroughly investigated in cirrhosis. The aim of this study was to compare the prognostic accuracy of ALBI, MELD, MELD with sodium (MELD-Na), CP, and the corrected for creatinine CP scores in a genetically homogeneous Cretan cirrhotic population. Methods One hundred ninety-five outpatients or hospitalized cirrhotics (127 male, median age 66 years) were studied over a period of 2 years and ALBI, platelet-albumin-bilirubin, MELD, MELD-Na, CP score, and 2 types of modified CP score (CP-I and CP-II) with serum creatinine were calculated and correlated with survival. Results ALBI had an optimum balance between sensitivity and specificity (area under the curve 0.704, 95% confidence interval [CI] 0.630-0.778) compared to the other scores. In the multivariate analysis, the only factors independently associated with death were the ALBI score (hazard ratio [HR] 2.51, 95%CI 1.69-3.73; P<0.001), the MELD-Na score (HR 1.04, 95%CI 1.00-1.09; P=0.045), and age (HR 1.05, 95%CI 1.03-1.07; P<0.001). When only decompensated cirrhosis was evaluated, the multivariate analysis showed that the ALBI score (HR 3.03; 95%CI 1.92-4.78; P<0.001), and age (HR 1.05, 95%CI 1.03-1.07; P<0.001) were independently associated with death. Conclusion ALBI score might be a better prognostic indicator of mortality in cirrhosis and given its simplicity could substitute for the CP, MELD, and MELD-Na scores.

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Section: Discussionmentioning

confidence: 99%

Comparative evaluation of ALBI, MELD, and Child-Pugh scores in prognosis of cirrhosis: is ALBI the new alternative?

Fragaki

Sifaki-Pistolla

Orfanoudaki

2019

aog

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“…On the other hand, low SMM is currently accepted as an adverse predictor in LC patients [17,18,19,20,21,22,23,24,25,26,27,28,29]. As described above, predictive models combining the ALBI grade and other parameters such as PALBI (combined ALBI and platelet count) or ALBI-T (combined ALBI and tumor status) have been put forward [13,14,15,16]. The ALBI grade does not incorporate SMM and we hypothesized that combination of these have potential to exert more accurate predictability for LC patients.…”

Section: Discussionmentioning

confidence: 99%

“…The predictability of ALBI grade has been verified in LC patients with or without HCC, regardless of liver disease etiologies [6,7,8,9,10,11,12]. More recently, a combined ALBI grade and other parameter grading systems has been proposed for the better prognostic ability over the ALBI grade [13,14,15,16].…”

Section: Introductionmentioning

confidence: 99%

Combined Albumin-Bilirubin Grade and Skeletal Muscle Mass as a Predictor in Liver Cirrhosis

Nishikawa

Enomoto

Iwata

et al. 2019

JCM

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We aimed to compare the prognostic impact among albumin-bilirubin (ALBI) grade, the Child-Pugh classification and our proposed combined ALBI grade and skeletal muscle mass (SMM) grading system in patients with liver cirrhosis (LC) (n = 468, 254 males and 214 females) using the Akaike information criterion (AIC) and time-dependent receiver operating characteristics (ROC) curve analysis. SMM was tested using bioimpedance analysis. Male subjects with skeletal muscle mass index (SMI) <7.0 cm2/m2 and female subjects with SMI <5.7 cm2/m2 were defined as having low SMM. Patients with ALBI grade 1, 2 and 3 were given 1, 2 and 3 points. Patients with and without low SMM were given 1 and 0 point, respectively. The sum of the point of ALBI (1, 2, or 3) and SMM (0 or 1) was defined as the ALBI-SMM grade. The value obtained with the AIC for survival by the ALBI-SMM grade was the lowest among three assessment methods (AIC: 513.418 in ALBI grade, 533.584 in Child-Pugh classification and 493.72 in ALBI-SMM grade). In time-dependent ROC analysis, all area under the ROCs of the ALBI-SMM grade in each time point were the highest among three assessment methods. In conclusion, the ALBI-SMM grading system can be helpful for LC patients.

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“…Preventive care for stable patients with cirrhosis is currently underdeveloped even though early intervention including choice and dosing of medication can mitigate symptom development. An essential step needed to develop effective early intervention protocols is the ability to predict the risk of decompensation 4 . The blood based HepQuant‐SHUNT test (SHUNT test) uses the dual clearances of cholate after oral and intravenous administration to quantify liver function and physiology, is minimally invasive, and may fill the gap in detection of patients at risk for decompensation.…”

Section: Introductionmentioning

confidence: 99%

Predicting clinical decompensation in patients with cirrhosis using the Hepquant‐SHUNT test

Fallahzadeh

Hansen

Trotter

et al. 2021

Aliment Pharmacol Ther

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SummaryBackgroundEarly identification of risk for decompensation in clinically stable cirrhotic patients helps specialists target early interventions and supports effective referrals from primary care providers to specialty centres.AimsTo examine whether the HepQuant‐SHUNT test (HepQuant LLC, Greenwood Village, Colorado, USA) predicts decompensation and the need for liver transplantation, hospitalisation or liver‐related death.MethodsThirty‐five compensated and 35 subjects with a previous episode of decompensation underwent the SHUNT Test and were followed for a median of 4.2 years. The disease severity index (DSI) (range 0‐50) was examined for association with decompensation in compensated patients; and liver transplantation, liver‐related death, and the number and days of liver related hospitalisations in all. DSI prediction of decompensation was also evaluated in 84 subjects with compensated cirrhosis from the Hepatitis C Antiviral Long‐Term Treatment against Cirrhosis Trial (HALT‐C) followed for a median of 5.8 years.ResultsAt baseline, subjects with prior decompensation had significantly higher DSI than compensated subjects (32.6 vs 20.9, P < 0.001). DSI ≥24 distinguished the decompensated from the compensated patients and independently predicted adverse clinical outcomes (hazard ratio: 4.92, 95% confidence interval: 1.42‐17.06). In the HALT‐C cohort, 65% with baseline DSI ≥24 vs 19% with DSI <24 experienced adverse clinical outcomes (relative risk 3.45, P < 0.0001).ConclusionsThe SHUNT test is a novel, noninvasive test that predicts risk of decompensation in previously compensated patients. DSI ≥24 is independently associated with risk for clinical decompensation, liver transplantation, death and hospitalisation.

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Validation of a Model for Identification of Patients With Compensated Cirrhosis at High Risk of Decompensation

Abstract: The funder had no involvement in study design, writing the report or decision for publication.No conflicts of interest for all authors listed.

Cited by 42 publications

References 27 publications

Comparative evaluation of ALBI, MELD, and Child-Pugh scores in prognosis of cirrhosis: is ALBI the new alternative?

Comparative evaluation of ALBI, MELD, and Child-Pugh scores in prognosis of cirrhosis: is ALBI the new alternative?

Combined Albumin-Bilirubin Grade and Skeletal Muscle Mass as a Predictor in Liver Cirrhosis

Predicting clinical decompensation in patients with cirrhosis using the Hepquant‐SHUNT test

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