Prognostic performance of a series of model for end‑stage liver disease and respective Δ scores in patients with hepatitis B acute-on-chronic liver failure

Xun,Yun-Hao; Shi,Jun-Ping; Li,Chun-Qing; Li,Dan; Shi,Wei-Zhen; Pan,Qing-Chun; Guo,Jian-Chun; Zang,Guo-Qing

doi:10.3892/mmr.2014.1983

Prognostic performance of a series of model for end‑stage liver disease and respective Δ scores in patients with hepatitis B acute-on-chronic liver failure

Authors:
- Yun-Hao Xun
- Jun-Ping Shi
- Chun-Qing Li
- Dan Li
- Wei-Zhen Shi
- Qing-Chun Pan
- Jian-Chun Guo
- Guo-Qing Zang
View Affiliations

Affiliations: Department of Liver Diseases, Hangzhou Sixth People's Hospital/Xixi Hospital of Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang 310014, P.R. China, Department of Infectious Diseases, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, P.R. China
Published online on: February 25, 2014 https://doi.org/10.3892/mmr.2014.1983
Pages: 1559-1568
Copyright: © Xun et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY_NC 3.0].

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The present study aimed to compare the short-term prognostic performance of a series of model for end-stage liver disease (MELD) and respective delta (∆) scores scoring systems in a population with acute-on-chronic hepatitis B liver failure (ACHBLF), and to investigate the potential effects from antivirals. A total of 77 patients with ACHBLF of mean age 46 years, 82% male, with 58.4% receiving antivirals, were recruited for this study. The ∆ scores for MELDs were defined as the changes one week after admission. Thirty‑eight (49%) patients (22 treated with antivirals) died within three months. The mean MELD and ∆MELD scores of the survival group were 19.5±4.4 and 0.2±3.7 respectively, and those of the mortality group were 23.5±5.5 and 7.9±6, respectively. The area under the receiver operating characteristic curve (AUC) for MELD, integrated MELD (iMELD), MELD with the addition of serum sodium (MELD-Na), updated MELD (upMELD), MELD excluding the international normalized ratio (INR; MELD-XI), United Kingdom MELD (UKMELD) and their ∆ scores were 0.72, 0.81, 0.77, 0.69, 0.65, 0.77 and 0.86, 0.83, 0.83, 0.82, 0.79 and 0.79, respectively. iMELD and MELD-Na significantly improved the accuracy of MELD (P<0.05). A cut-off value of 41.5 for the iMELD score can prognose 71% of mortalities with a specificity of 85%. In each pair of models, the ∆ score was superior to its counterpart, particularly when applied to patients with MELD ≤30. Decreased accuracy was observed for all models in the subset of patients treated with antivirals, although their baseline characteristics were comparable to those of untreated patients, while iMELD, MELD-Na and respective ∆ models remained superior with regard to the predictability. The iMELD and MELD-Na models predicted three-month mortality more accurately, while the ∆ models were superior to their counterparts when MELD ≤30; however, their performance was altered by antivirals, and thus requires optimization.

View Figures

View References

1	Sarin SK, Kumar A, Almeida JA, et al: Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL). Hepatol Int. 3:269–282. 2009. View Article : Google Scholar
2	Wong VW and Chan HL: Severe acute exacerbation of chronic hepatitis B: a unique presentation of a common disease. J Gastroenterol Hepatol. 24:1179–1186. 2009. View Article : Google Scholar : PubMed/NCBI
3	Kamath PS and Kim WR; Advanced Liver Disease Study Group. The model for end-stage liver disease (MELD). Hepatology. 45:797–805. 2007. View Article : Google Scholar
4	Gitto S, Lorenzini S, Biselli M, Conti F, Andreone P and Bernardi M: Allocation priority in non-urgent liver transplantation: an overview of proposed scoring systems. Dig Liver Dis. 41:700–706. 2009. View Article : Google Scholar : PubMed/NCBI
5	Sun LJ, Yu JW, Zhao YH, Kang P and Li SC: Influential factors of prognosis in lamivudine treatment for patients with acute-on-chronic hepatitis B liver failure. J Gastroenterol Hepatol. 25:583–590. 2010. View Article : Google Scholar : PubMed/NCBI
6	Sun QF, Ding JG, Xu DZ, et al: Prediction of the prognosis of patients with acute-on-chronic hepatitis B liver failure using the model for end-stage liver disease scoring system and a novel logistic regression model. J Viral Hepat. 16:464–470. 2009. View Article : Google Scholar : PubMed/NCBI
7	Yu JW, Sun LJ, Zhao YH and Li SC: Prediction value of model for end-stage liver disease scoring system on prognosis in patients with acute-on-chronic hepatitis B liver failure after plasma exchange and lamivudine treatment. J Gastroenterol Hepatol. 23:1242–1249. 2008. View Article : Google Scholar
8	Lee WC, Chou HS, Wu TJ, Lee CS, Lee CF and Chan KM: Indicators and outcome of liver transplantation in acute liver decompensation after flares of hepatitis B. J Viral Hepat. 18:193–199. 2011. View Article : Google Scholar : PubMed/NCBI
9	Zheng MH, Shi KQ, Fan YC, Li H, Ye C, Chen QQ and Chen YP: A model to determine 3-month mortality risk in patients with acute-on-chronic hepatitis B liver failure. Clin Gastroenterol Hepatol. 9:351–356. 2011. View Article : Google Scholar : PubMed/NCBI
10	Cai CJ, Chen HA, Lu MQ and Chen GH: Model for end-stage liver disease-sodium predicts prognosis in patients with chronic severe hepatitis B. Chin Med J (Engl). 121:2065–2069. 2008.
11	Lee WM, Squires RH Jr, Nyberg SL, Doo E and Hoofnagle JH: Acute liver failure: summary of a workshop. Hepatology. 47:1401–1415. 2008.PubMed/NCBI
12	Novelli G, Rossi M, Ferretti G, Pugliese F, Travaglia D, Guidi S, Novelli S, Lai Q, Morabito V and Berloco PB: Predictive parameters after molecular absorbent recirculating system treatment integrated with model for end stage liver disease model in patients with acute-on-chronic liver failure. Transplant Proc. 42:1182–1187. 2010. View Article : Google Scholar
13	Garg H, Sarin SK, Kumar M, Garg V, Sharma BC and Kumar A: Tenofovir improves the outcome in patients with spontaneous reactivation of hepatitis B presenting as acute-on-chronic liver failure. Hepatology. 53:774–780. 2011. View Article : Google Scholar : PubMed/NCBI
14	Liu Q, Liu Z, Wang T, Wang Q, Shi X and Dao W: Characteristics of acute and sub-acute liver failure in China: nomination, classification and interval. J Gastroenterol Hepatol. 22:2101–2106. 2007. View Article : Google Scholar : PubMed/NCBI
15	Liu XY, Hu JH, Wang HF and Chen JM: Etiological analysis of 1977 patients with acute liver failure, subacute liver failure and acute-on-chronic liver failure. Zhonghua Gan Zang Bing Za Zhi. 16:772–775. 2008.(In Chinese).
16	Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D’Amico G, Dickson ER and Kim WR: A model to predict survival in patients with end-stage liver disease. Hepatology. 33:464–470. 2001. View Article : Google Scholar : PubMed/NCBI
17	Sharma P, Schaubel DE, Sima CS, Merion RM and Lok AS: Re-weighting the model for end-stage liver disease score components. Gastroenterology. 135:1575–1581. 2008. View Article : Google Scholar : PubMed/NCBI
18	Luca A, Angermayr B, Bertolini G, Koenig F, Vizzini G, Ploner M, Peck-Radosavljevic M, Gridelli B and Bosch J: An integrated MELD model including serum sodium and age improves the prediction of early mortality in patients with cirrhosis. Liver Transpl. 13:1174–1180. 2007. View Article : Google Scholar : PubMed/NCBI
19	Heuman DM, Mihas AA, Habib A, Gilles HS, Stravitz RT, Sanyal AJ and Fisher RA: MELD-XI: a rational approach to ‘sickest first’ liver transplantation in cirrhotic patients requiring anticoagulant therapy. Liver Transpl. 13:30–37. 2007.PubMed/NCBI
20	Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, Edwards E and Therneau TM: Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 359:1018–1026. 2008. View Article : Google Scholar : PubMed/NCBI
21	Neuberger J, Gimson A, Davies M, Akyol M, O’Grady J, Burroughs A and Hudson M; Liver Advisory Group. UK Blood and Transplant: Selection of patients for liver transplantation and allocation of donated livers in the UK. Gut. 57:252–257. 2008. View Article : Google Scholar : PubMed/NCBI
22	Bewick V, Cheek L and Ball J: Statistics review 13: receiver operating characteristic curves. Crit Care. 8:508–512. 2004. View Article : Google Scholar : PubMed/NCBI
23	DeLong ER, DeLong DM and Clarke-Pearson DL: Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 44:837–845. 1988. View Article : Google Scholar : PubMed/NCBI
24	Biggins SW, Rodriguez HJ, Bacchetti P, Bass NM, Roberts JP and Terrault NA: Serum sodium predicts mortality in patients listed for liver transplantation. Hepatology. 41:32–39. 2005. View Article : Google Scholar : PubMed/NCBI
25	Huo SC, Huo TI, Lin HC, Chi CW, Lee PC, Tseng FW and Lee SD: Is the corrected-creatinine model for end-stage liver disease a feasible strategy to adjust gender difference in organ allocation for liver transplantation? Transplantation. 84:1406–1412. 2007. View Article : Google Scholar
26	Merion RM, Wolfe RA, Dykstra DM, Leichtman AB, Gillespie B and Held PJ: Longitudinal assessment of mortality risk among candidates for liver transplantation. Liver Transpl. 9:12–18. 2003. View Article : Google Scholar : PubMed/NCBI
27	Huo TI, Wu JC, Lin HC, Lee FY, Hou MC, Lee PC, Chang FY and Lee SD: Evaluation of the increase in model for end-stage liver disease (DeltaMELD) score over time as a prognostic predictor in patients with advanced cirrhosis: risk factor analysis and comparison with initial MELD and Child-Turcotte-Pugh score. J Hepatol. 42:826–832. 2005. View Article : Google Scholar
28	Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Diseases and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. Diagnostic and treatment guidelines for liver failure. Zhonghua Gan Zang Bing Za Zhi. 14:643–646. 2006.(In Chinese).
29	Wong VW, Wong GL, Yiu KK, Chim AM, Chu SH, Chan HY, Sung JJ and Chan HL: Entecavir treatment in patients with severe acute exacerbation of chronic hepatitis B. J Hepatol. 54:236–242. 2011. View Article : Google Scholar : PubMed/NCBI
30	Lange CM, Bojunga J, Hofmann WP, Wunder K, Mihm U, Zeuzem S and Sarrazin C: Severe lactic acidosis during treatment of chronic hepatitis B with entecavir in patients with impaired liver function. Hepatology. 50:2001–2006. 2009. View Article : Google Scholar : PubMed/NCBI
31	Christensen E: Prognostic models including the Child-Pugh, MELD and Mayo risk scores–where are we and where should we go? J Hepatol. 41:344–350. 2004.PubMed/NCBI