Evidence-based incorporation of key parameters into MELD score for acute-on-chronic liver failure.

eGastroenterology Pub Date : 2024-10-01 eCollection Date: 2024-09-01 DOI:10.1136/egastro-2024-100101
Xia Yu, Ruoqi Zhou, Wenting Tan, Xiaobo Wang, Xin Zheng, Yan Huang, Jinjun Chen, Beiling Li, Xinxin Liu, Zhiwei Li, Zhongji Meng, Yanhang Gao, Zhiping Qian, Feng Liu, Xiaobo Lu, Jia Shang, Huadong Yan, Yubao Zheng, Weituo Zhang, Shan Yin, Wenyi Gu, Guohong Deng, Xiaomei Xiang, Yi Zhou, Yixin Hou, Qun Zhang, Shue Xiong, Jing Liu, Ruochan Chen, Liyuan Long, Xiuhua Jiang, Sen Luo, Yuanyuan Chen, Chang Jiang, Jinming Zhao, Liujuan Ji, Xue Mei, Jing Li, Tao Li, Rongjiong Zheng, Xinyi Zhou, Qun Cai, Hai Li, Jifang Sheng, Yu Shi
{"title":"Evidence-based incorporation of key parameters into MELD score for acute-on-chronic liver failure.","authors":"Xia Yu, Ruoqi Zhou, Wenting Tan, Xiaobo Wang, Xin Zheng, Yan Huang, Jinjun Chen, Beiling Li, Xinxin Liu, Zhiwei Li, Zhongji Meng, Yanhang Gao, Zhiping Qian, Feng Liu, Xiaobo Lu, Jia Shang, Huadong Yan, Yubao Zheng, Weituo Zhang, Shan Yin, Wenyi Gu, Guohong Deng, Xiaomei Xiang, Yi Zhou, Yixin Hou, Qun Zhang, Shue Xiong, Jing Liu, Ruochan Chen, Liyuan Long, Xiuhua Jiang, Sen Luo, Yuanyuan Chen, Chang Jiang, Jinming Zhao, Liujuan Ji, Xue Mei, Jing Li, Tao Li, Rongjiong Zheng, Xinyi Zhou, Qun Cai, Hai Li, Jifang Sheng, Yu Shi","doi":"10.1136/egastro-2024-100101","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The model for end-stage liver disease (MELD) score is widely used for the prognostication in end-stage liver disease but has limited performance in acute-on-chronic liver failure (ACLF). In this study, we identified additional predictive parameters and reformed the MELD score to predict ACLF more accurately.</p><p><strong>Methods: </strong>A meta-analysis was performed on relevant studies to identify the predictive factors of 28-day/90-day outcomes of ACLF, which were validated in two large prospective cohorts. A prognostic score was developed by incorporating predictive parameters into the MELD score. The model was evaluated with a focus on discrimination and calibration.</p><p><strong>Results: </strong>The meta-analysis incorporated 32 cohort studies with a total of 13 939 patients, of which 13 risk factors were identified, and 3 risk factors (age, neutrophil count and hepatic encephalopathy (HE) grade) besides MELD score were validated in 751 patients with ACLF derived from two prospective cohorts. A new model (Chinese Acute-on-Chronic Liver Failure Consortium (CATCH-LIFE)-MELD score) was developed as follows: 0.028×age+0.3×HE grade+0.039×neutrophil count+0.079×MELD score. CATCH-LIFE-MELD score achieved a concordance index of 0.791/0.788 for 28-day/90-day outcomes, which is superior to other traditional scores. Other discrimination indices, including net reclassification improvement, integrated discrimination improvement and probability density function, and calibration including Nagelkerke's R<sup>2</sup> and Brier scores confirmed its superiority. Moreover, the accuracy of CATCH-LIFE-MELD score remained stable. It was highest in patients with or without hepatitis B virus infection, cirrhosis, liver failure or under the Chinese Group on the Study of Severe Hepatitis B (COSSH) criteria or European Association for the Study of the Liver (EASL) criteria. All results were substantiated by an evaluation using an external cohort.</p><p><strong>Conclusions: </strong>CATCH-LIFE-MELD score, a modified MELD score exhibited improved accuracy in predicting the short-term prognosis of ACLF than other traditional scores.</p>","PeriodicalId":72879,"journal":{"name":"eGastroenterology","volume":"2 3","pages":"e100101"},"PeriodicalIF":0.0000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770428/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"eGastroenterology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1136/egastro-2024-100101","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Background: The model for end-stage liver disease (MELD) score is widely used for the prognostication in end-stage liver disease but has limited performance in acute-on-chronic liver failure (ACLF). In this study, we identified additional predictive parameters and reformed the MELD score to predict ACLF more accurately.

Methods: A meta-analysis was performed on relevant studies to identify the predictive factors of 28-day/90-day outcomes of ACLF, which were validated in two large prospective cohorts. A prognostic score was developed by incorporating predictive parameters into the MELD score. The model was evaluated with a focus on discrimination and calibration.

Results: The meta-analysis incorporated 32 cohort studies with a total of 13 939 patients, of which 13 risk factors were identified, and 3 risk factors (age, neutrophil count and hepatic encephalopathy (HE) grade) besides MELD score were validated in 751 patients with ACLF derived from two prospective cohorts. A new model (Chinese Acute-on-Chronic Liver Failure Consortium (CATCH-LIFE)-MELD score) was developed as follows: 0.028×age+0.3×HE grade+0.039×neutrophil count+0.079×MELD score. CATCH-LIFE-MELD score achieved a concordance index of 0.791/0.788 for 28-day/90-day outcomes, which is superior to other traditional scores. Other discrimination indices, including net reclassification improvement, integrated discrimination improvement and probability density function, and calibration including Nagelkerke's R2 and Brier scores confirmed its superiority. Moreover, the accuracy of CATCH-LIFE-MELD score remained stable. It was highest in patients with or without hepatitis B virus infection, cirrhosis, liver failure or under the Chinese Group on the Study of Severe Hepatitis B (COSSH) criteria or European Association for the Study of the Liver (EASL) criteria. All results were substantiated by an evaluation using an external cohort.

Conclusions: CATCH-LIFE-MELD score, a modified MELD score exhibited improved accuracy in predicting the short-term prognosis of ACLF than other traditional scores.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
求助全文
约1分钟内获得全文 去求助
来源期刊
自引率
0.00%
发文量
0
期刊最新文献
Functional dyspepsia and gastroparesis: are they distinct disorders, a spectrum of diseases or one disease? Modifiable factors for irritable bowel syndrome: evidence from Mendelian randomisation approach. Essential roles of the unfolded protein response in intestinal physiology. Faecal microbiota transplantation for eradicating Helicobacter pylori infection: clinical practice and theoretical postulation. Endocrine pathology in young rabbits with cystic fibrosis.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1