A model to predict survival in patients with end-stage liver disease

HepatologyVolume 33, Issue 2 p. 464-470 Special ArticleFree Access A model to predict survival in patients with end-stage liver disease Patrick S. Kamath, Patrick S. Kamath Division of Gastroenterology and HepatologySearch for more papers by this authorRussell H. Wiesner, Russell H. Wiesner Division of Gastroenterology and HepatologySearch for more papers by this authorMichael Malinchoc, Michael Malinchoc Department of Health Science Research, Mayo Clinic and Foundation, Rochester, MNSearch for more papers by this authorWalter Kremers, Walter Kremers Department of Health Science Research, Mayo Clinic and Foundation, Rochester, MNSearch for more papers by this authorTerry M. Therneau, Terry M. Therneau Department of Health Science Research, Mayo Clinic and Foundation, Rochester, MNSearch for more papers by this authorCatherine L. Kosberg, Catherine L. Kosberg Division of Gastroenterology and HepatologySearch for more papers by this authorGennaro D'Amico, Gennaro D'Amico Divisione di Medicina, Ospedale V Cervello, Palermo, ItalySearch for more papers by this authorE. Rolland Dickson, E. Rolland Dickson Division of Gastroenterology and HepatologySearch for more papers by this authorW. Ray Kim M.D., M.B.A., Corresponding Author W. Ray Kim M.D., M.B.A. kim.woong@mayo.edu Division of Gastroenterology and Hepatology Department of Health Science Research, Mayo Clinic and Foundation, Rochester, MNGastroenterology and Hepatology (Ch10), Mayo Clinic and Foundation, 200 First Street, SW, Rochester, MN 55905. fax: 507-266-2810.===Search for more papers by this author Patrick S. Kamath, Patrick S. Kamath Division of Gastroenterology and HepatologySearch for more papers by this authorRussell H. Wiesner, Russell H. Wiesner Division of Gastroenterology and HepatologySearch for more papers by this authorMichael Malinchoc, Michael Malinchoc Department of Health Science Research, Mayo Clinic and Foundation, Rochester, MNSearch for more papers by this authorWalter Kremers, Walter Kremers Department of Health Science Research, Mayo Clinic and Foundation, Rochester, MNSearch for more papers by this authorTerry M. Therneau, Terry M. Therneau Department of Health Science Research, Mayo Clinic and Foundation, Rochester, MNSearch for more papers by this authorCatherine L. Kosberg, Catherine L. Kosberg Division of Gastroenterology and HepatologySearch for more papers by this authorGennaro D'Amico, Gennaro D'Amico Divisione di Medicina, Ospedale V Cervello, Palermo, ItalySearch for more papers by this authorE. Rolland Dickson, E. Rolland Dickson Division of Gastroenterology and HepatologySearch for more papers by this authorW. Ray Kim M.D., M.B.A., Corresponding Author W. Ray Kim M.D., M.B.A. kim.woong@mayo.edu Division of Gastroenterology and Hepatology Department of Health Science Research, Mayo Clinic and Foundation, Rochester, MNGastroenterology and Hepatology (Ch10), Mayo Clinic and Foundation, 200 First Street, SW, Rochester, MN 55905. fax: 507-266-2810.===Search for more papers by this author First published: 30 December 2003 https://doi.org/10.1053/jhep.2001.22172Citations: 3,329AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Abstract A recent mandate emphasizes severity of liver disease to determine priorities in allocating organs for liver transplantation and necessitates a disease severity index based on generalizable, verifiable, and easily obtained variables. The aim of the study was to examine the generalizability of a model previously created to estimate survival of patients undergoing the transjugular intrahepatic portosystemic shunt (TIPS) procedure in patient groups with a broader range of disease severity and etiology. The Model for End-Stage Liver Disease (MELD) consists of serum bilirubin and creatinine levels, International Normalized Ratio (INR) for prothrombin time, and etiology of liver disease. The model's validity was tested in 4 independent data sets, including (1) patients hospitalized for hepatic decompensation (referred to as “hospitalized” patients), (2) ambulatory patients with noncholestatic cirrhosis, (3) patients with primary biliary cirrhosis (PBC), and (4) unselected patients from the 1980s with cirrhosis (referred to as “historical” patients). In these patients, the model's ability to classify patients according to their risk of death was examined using the concordance (c)-statistic. The MELD scale performed well in predicting death within 3 months with a c-statistic of (1) 0.87 for hospitalized patients, (2) 0.80 for noncholestatic ambulatory patients, (3) 0.87 for PBC patients, and (4) 0.78 for historical cirrhotic patients. Individual complications of portal hypertension had minimal impact on the model's prediction (range of improvement in c-statistic: <.01 for spontaneous bacterial peritonitis and variceal hemorrhage to ascites: 0.01-0.03). The MELD scale is a reliable measure of mortality risk in patients with end-stage liver disease and suitable for use as a disease severity index to determine organ allocation priorities. Citing Literature Volume33, Issue2February 2001Pages 464-470 ReferencesRelatedInformation