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Clinician assessments of health status predict mortality in patients with end‐stage liver disease awaiting liver transplantation
Author(s) -
Lai Jennifer C.,
Covinsky Kenneth E.,
Hayssen Hilary,
Lizaola Blanca,
Dodge Jennifer L.,
Roberts John P.,
Terrault Norah A.,
Feng Sandy
Publication year - 2015
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/liv.12792
Subject(s) - medicine , liver disease , liver transplantation , odds ratio , logistic regression , model for end stage liver disease , disease , odds , transplantation , stage (stratigraphy) , paleontology , biology
Background & Aims The US liver allocation system effectively prioritizes most liver transplant candidates by disease severity as assessed by the Model for End‐Stage Liver Disease ( MELD ) score. Yet, one in five dies on the wait‐list. We aimed to determine whether clinician assessments of health status could identify this subgroup of patients at higher risk for wait‐list mortality. Methods From 2012–2013, clinicians of all adult liver transplant candidates with laboratory MELD ≥12 were asked at the clinic visit: ‘How would you rate your patient's overall health today (0 = excellent, 5 = very poor)?' The odds of death/delisting for being too sick for the transplant by clinician‐assessment score ≥3 vs. <3 were assessed by logistic regression. Results Three hundred and forty‐seven liver transplant candidates (36% female) had a mean follow‐up of 13 months. Men differed from women by disease aetiology (<0.01) but were similar in age and markers of liver disease severity ( P > 0.05). Mean clinician assessment differed between men and women (2.3 vs. 2.6; P = 0.02). The association between clinician‐assessment and MELD was ρ = 0.28 ( P < 0.01). 53/347 (15%) died/were delisted. In univariable analysis, a clinician‐assessment score ≥ 3 was associated with increased odds of death/delisting (2.57; 95% CI 1.42–4.66). After adjustment for MELD and age, a clinician‐assessment score ≥ 3 was associated with 2.25 (95% CI 1.22–4.15) times the odds of death/delisting compared to a clinician‐assessment score < 3. Conclusions A standardized clinician assessment of health status can identify liver transplant candidates at high risk for wait‐list mortality independent of MELD score. Objectifying this ‘eyeball test’ may inform interventions targeted at this vulnerable subgroup to optimize wait‐list outcomes.