Evidence-based incorporation of key parameters into MELD score for acute-on-chronic liver failure
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 A...
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2024-10-01
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| Series: | eGastroenterology |
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| author | Jing Liu Tao Li Yi Zhou Yuanyuan Chen Hai Li Yan Huang Jing Li Yu Shi Xin Zheng Yanhang Gao Xinxin Liu Weituo Zhang Shan Yin Xia Yu Jifang Sheng Zhiwei Li Feng Liu Guohong Deng Jinjun Chen Zhongji Meng Zhiping Qian Xiaobo Lu Wenyi Gu Qun Cai Xiaobo Wang Qun Zhang Xue Mei Wenting Tan Jia Shang Xinyi Zhou Chang Jiang Ruoqi Zhou Beiling Li Huadong Yan Yubao Zheng Xiaomei Xiang Yixin Hou Shue Xiong Ruochan Chen Liyuan Long Xiuhua Jiang Sen Luo Jinming Zhao Liujuan Ji Rongjiong Zheng |
| author_facet | Jing Liu Tao Li Yi Zhou Yuanyuan Chen Hai Li Yan Huang Jing Li Yu Shi Xin Zheng Yanhang Gao Xinxin Liu Weituo Zhang Shan Yin Xia Yu Jifang Sheng Zhiwei Li Feng Liu Guohong Deng Jinjun Chen Zhongji Meng Zhiping Qian Xiaobo Lu Wenyi Gu Qun Cai Xiaobo Wang Qun Zhang Xue Mei Wenting Tan Jia Shang Xinyi Zhou Chang Jiang Ruoqi Zhou Beiling Li Huadong Yan Yubao Zheng Xiaomei Xiang Yixin Hou Shue Xiong Ruochan Chen Liyuan Long Xiuhua Jiang Sen Luo Jinming Zhao Liujuan Ji Rongjiong Zheng |
| author_sort | Jing Liu |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-d55cef17dcf943f2816cb72aae9e5307 |
| institution | Kabale University |
| issn | 2766-0125 2976-7296 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | eGastroenterology |
| spelling | doaj-art-d55cef17dcf943f2816cb72aae9e53072025-01-06T11:45:12ZengBMJ Publishing GroupeGastroenterology2766-01252976-72962024-10-012310.1136/egastro-2024-100101Evidence-based incorporation of key parameters into MELD score for acute-on-chronic liver failureJing Liu0Tao Li1Yi Zhou2Yuanyuan Chen3Hai Li4Yan Huang5Jing Li6Yu Shi7Xin Zheng8Yanhang Gao9Xinxin Liu10Weituo Zhang11Shan Yin12Xia Yu13Jifang Sheng14Zhiwei Li15Feng Liu16Guohong Deng17Jinjun Chen18Zhongji Meng19Zhiping Qian20Xiaobo Lu21Wenyi Gu22Qun Cai23Xiaobo Wang24Qun Zhang25Xue Mei26Wenting Tan27Jia Shang28Xinyi Zhou29Chang Jiang30Ruoqi Zhou31Beiling Li32Huadong Yan33Yubao Zheng34Xiaomei Xiang35Yixin Hou36Shue Xiong37Ruochan Chen38Liyuan Long39Xiuhua Jiang40Sen Luo41Jinming Zhao42Liujuan Ji43Rongjiong Zheng44Department of Rheumatology and Immunology Research Institute, Affiliated Hospital of North Sichuan Medical College, Nanchong, China13 Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People`s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, ChinaSchool of Nursing, Langfang Health Vocational College, Langfang, Hebei, China8 Department of Infectious Disease, Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, Chinaassociate professor5 Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, ChinaophthalmologistDepartment of Rheumatology, Children`s Hospital of Fudan University, National Children`s Medical Center, Shanghai, People`s Republic of ChinaDepartment of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, Guangdong, China9 Department of Hepatology, The First Hospital of Jilin University, Changchun, China1 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China17 Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China18 Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China1 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China1 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China7 Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, ChinaNational Clinical Research Center for Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China2 Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China6 Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China8 Department of Infectious Disease, Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, China10 Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Centre, Fudan University, Shanghai, China13 Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China18 Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China19 Department of Infectious Diseases and Liver Diseases, Ningbo Medical Center Lihuili Hospital, Affiliated Lihuili Hospital of Ningbo University, Ningbo, China3 Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China3 Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China10 Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Centre, Fudan University, Shanghai, China2 Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China14 Department of Infectious Diseases, Henan Provincial People`s Hospital, Zhengzhou, China13 Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China9 Department of Hepatology, The First Hospital of Jilin University, Changchun, China1 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China6 Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China15 Department of Infectious Disease, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University, Shulan International Medical College, Hangzhou, China16 The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China2 Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China3 Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China4 Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China5 Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, China5 Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, China6 Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China8 Department of Infectious Disease, Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, China9 Department of Hepatology, The First Hospital of Jilin University, Changchun, China10 Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Centre, Fudan University, Shanghai, China13 Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, ChinaBackground 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.https://egastroenterology.bmj.com/content/2/3/e100101.full |
| spellingShingle | Jing Liu Tao Li Yi Zhou Yuanyuan Chen Hai Li Yan Huang Jing Li Yu Shi Xin Zheng Yanhang Gao Xinxin Liu Weituo Zhang Shan Yin Xia Yu Jifang Sheng Zhiwei Li Feng Liu Guohong Deng Jinjun Chen Zhongji Meng Zhiping Qian Xiaobo Lu Wenyi Gu Qun Cai Xiaobo Wang Qun Zhang Xue Mei Wenting Tan Jia Shang Xinyi Zhou Chang Jiang Ruoqi Zhou Beiling Li Huadong Yan Yubao Zheng Xiaomei Xiang Yixin Hou Shue Xiong Ruochan Chen Liyuan Long Xiuhua Jiang Sen Luo Jinming Zhao Liujuan Ji Rongjiong Zheng Evidence-based incorporation of key parameters into MELD score for acute-on-chronic liver failure eGastroenterology |
| title | Evidence-based incorporation of key parameters into MELD score for acute-on-chronic liver failure |
| title_full | Evidence-based incorporation of key parameters into MELD score for acute-on-chronic liver failure |
| title_fullStr | Evidence-based incorporation of key parameters into MELD score for acute-on-chronic liver failure |
| title_full_unstemmed | Evidence-based incorporation of key parameters into MELD score for acute-on-chronic liver failure |
| title_short | Evidence-based incorporation of key parameters into MELD score for acute-on-chronic liver failure |
| title_sort | evidence based incorporation of key parameters into meld score for acute on chronic liver failure |
| url | https://egastroenterology.bmj.com/content/2/3/e100101.full |
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