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

January 31, 2001

Hepatology--February 2001 Volume 33 Number 2

Special Article

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 â?ohospitalizedâ? 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 â?ohistoricalâ? patients). In these

patients, the model's ability to classify patients according to their risk

of death was examined using the concordance ©-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. (HEPATOLOGY

2001;33:464-470.)

Abbreviations

IOM Institute of Medicine

CTP Child-Turcotte-Pugh

MELD Model for End-Stage Liver Disease

TIPS transjugular intrahepatic portosystemic shunt

PBC primary biliary cirrhosis

INR International Normalized Ratio

CI confidence interval

SBP spontaneous bacterial peritonitis

ISI International Sensitivity Index

January 31, 2001