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
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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.

以证据为基础将关键参数纳入急性慢性肝衰竭MELD评分。
背景:终末期肝病(MELD)评分模型被广泛用于终末期肝病的预后,但在急性慢性肝衰竭(ACLF)中的表现有限。在本研究中,我们确定了额外的预测参数,并对MELD评分进行了改革,以更准确地预测ACLF。方法:对相关研究进行荟萃分析,以确定ACLF 28天/90天预后的预测因素,并在两个大型前瞻性队列中进行验证。将预测参数纳入MELD评分,形成预后评分。对模型进行了评价,重点是判别和标定。结果:meta分析纳入了32项队列研究,共13939例患者,其中确定了13个危险因素,并在来自两个前瞻性队列的751例ACLF患者中验证了除MELD评分外的3个危险因素(年龄、中性粒细胞计数和肝性脑病(HE)分级)。新模型(中国急性-慢性肝衰竭联盟(CATCH-LIFE)-MELD评分)如下:0.028×age+0.3×HE分级+0.039×neutrophil计数+0.079×MELD评分。CATCH-LIFE-MELD评分28天/90天结局的一致性指数为0.791/0.788,优于其他传统评分。其他判别指标,包括净重分类改进、综合判别改进和概率密度函数,以及Nagelkerke's R2和Brier评分的校准,均证实了该方法的优越性。此外,CATCH-LIFE-MELD评分的准确性保持稳定。在有或没有乙型肝炎病毒感染、肝硬化、肝功能衰竭或符合中国重型乙型肝炎研究小组(COSSH)标准或欧洲肝脏研究协会(EASL)标准的患者中,死亡率最高。所有结果均通过外部队列评估得到证实。结论:CATCH-LIFE-MELD评分,一种改良的MELD评分在预测ACLF短期预后方面比其他传统评分具有更高的准确性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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