Premium
Occurrence of cirrhosis‐related complications is a time‐dependent prognostic predictor independent of baseline model for end‐stage liver disease score
Author(s) -
Huo TehIa,
Lin HanChieh,
Lee FaYauh,
Hou MingChih,
Lee PuiChing,
Wu JawChing,
Chang FullYoung,
Lee ShouDong
Publication year - 2006
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/j.1478-3231.2005.01190.x
Subject(s) - medicine , hepatorenal syndrome , spontaneous bacterial peritonitis , cirrhosis , model for end stage liver disease , liver transplantation , hepatic encephalopathy , gastroenterology , liver disease , esophageal varices , decompensation , complication , proportional hazards model , confidence interval , transplantation , surgery , portal hypertension
Background: The model for end‐stage liver disease (MELD) is used to prioritize cirrhotic patients awaiting liver transplantation. Many cirrhosis‐related complications are indications for transplantation but are not included in MELD. This study investigated the impact of these complications on survival and association with MELD. Methods: The mortality risk of cirrhosis‐related complications, including bleeding esophageal varices, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome and hepatic decompensation, was analyzed using a time‐dependent Cox regression model in 227 cirrhotic patients. Results: A total of 281 episodes of complications occurred in 142 (63%) patients. Patients who died had a significantly higher baseline MELD score compared with those who survived (14.5±4.5 vs 12.8±3.9, P =0.004). There was no significant difference in the MELD score between patients with and without the occurrence of complications (13.6±4.3 vs 12.9±4.0, P =0.093). Patients with a higher baseline MELD score tended to develop early complications (ρ=−0.598, P < 0.001). Using the Cox regression model, the risk ratio of mortality was 4.9 (95% confidence interval: 3.9–6.3, P < 0.0001) for each additional episode of complication. Conclusions: The mortality risk increases as the number of complication episodes increases. While patients with repeated complications have a poor outcome, they do not necessarily have a higher baseline MELD score and could be down‐staged in the MELD era.