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Prognostic performance of a series of model for end-stage liver disease and respective Δ scores in patients with hepatitis B acute-on-chronic liver failure.

Xun YH, Shi JP, Li CQ, Li D, Shi WZ, Pan QC, Guo JC, Zang GQ - Mol Med Rep (2014)

Bottom Line: In each pair of models, the ∆ score was superior to its counterpart, particularly when applied to patients with MELD ≤ 30.Decreased accuracy was observed for all models in the subset of patients treated with antivirals, although their baseline characteristics were comparable to those of untreated patients, while iMELD, MELD-Na and respective ∆ models remained superior with regard to the predictability.The iMELD and MELD-Na models predicted three-month mortality more accurately, while the ∆ models were superior to their counterparts when MELD ≤ 30; however, their performance was altered by antivirals, and thus requires optimization.

View Article: PubMed Central - PubMed

Affiliation: Department of Liver Diseases, Hangzhou Sixth People's Hospital/Xixi Hospital of Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang 310014, P.R. China.

ABSTRACT
The present study aimed to compare the short-term prognostic performance of a series of model for end-stage liver disease (MELD) and respective delta (∆) scores scoring systems in a population with acute-on-chronic hepatitis B liver failure (ACHBLF), and to investigate the potential effects from antivirals. A total of 77 patients with ACHBLF of mean age 46 years, 82% male, with 58.4% receiving antivirals, were recruited for this study. The ∆ scores for MELDs were defined as the changes one week after admission. Thirty‑eight (49%) patients (22 treated with antivirals) died within three months. The mean MELD and ∆MELD scores of the survival group were 19.5 ± 4.4 and 0.2 ± 3.7 respectively, and those of the mortality group were 23.5 ± 5.5 and 7.9 ± 6, respectively. The area under the receiver operating characteristic curve (AUC) for MELD, integrated MELD (iMELD), MELD with the addition of serum sodium (MELD-Na), updated MELD (upMELD), MELD excluding the international normalized ratio (INR; MELD-XI), United Kingdom MELD (UKMELD) and their ∆ scores were 0.72, 0.81, 0.77, 0.69, 0.65, 0.77 and 0.86, 0.83, 0.83, 0.82, 0.79 and 0.79, respectively. iMELD and MELD-Na significantly improved the accuracy of MELD (P<0.05). A cut-off value of 41.5 for the iMELD score can prognose 71% of mortalities with a specificity of 85%. In each pair of models, the ∆ score was superior to its counterpart, particularly when applied to patients with MELD ≤ 30. Decreased accuracy was observed for all models in the subset of patients treated with antivirals, although their baseline characteristics were comparable to those of untreated patients, while iMELD, MELD-Na and respective ∆ models remained superior with regard to the predictability. The iMELD and MELD-Na models predicted three-month mortality more accurately, while the ∆ models were superior to their counterparts when MELD ≤ 30; however, their performance was altered by antivirals, and thus requires optimization.

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Comparison of area under receiver operating characteristic (ROC) curves (AUC) for model for end-stage liver disease (MELD) and respective delta scores for the 3-month mortality assessment in acute-on-chronic hepatitis B liver failure (ACHBLF) patients with different characteristics. (A,B) all, (C,D) MELD score ≤30, (E,F) treated with antivirals, and (G,H) not treated with antivirals. For an explanation of MELD models, see previous tables.
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f1-mmr-09-05-1559: Comparison of area under receiver operating characteristic (ROC) curves (AUC) for model for end-stage liver disease (MELD) and respective delta scores for the 3-month mortality assessment in acute-on-chronic hepatitis B liver failure (ACHBLF) patients with different characteristics. (A,B) all, (C,D) MELD score ≤30, (E,F) treated with antivirals, and (G,H) not treated with antivirals. For an explanation of MELD models, see previous tables.

Mentions: The AUC was estimated to be >0.5 for all progostic models (0.647–0.807, P<0.05 for all) applied on all subjects; this value corresponds to a consistently appropriate sensitivity and specificity. The iMELD score had the highest AUC of 0.807 (95% CI, 0.71–0.905) with a sensitivity of 71.7% and a specificity of 84.6% for an optimal cut-off value of 41.5. It was followed by MELD-Na, UKMELD, MELD, upMELD and MELD-XI in terms of performance. Similar results were observed when model scores were compared at the same cut-off value and patients with MELD score >30 were excluded, with only MELD-XI failing to predict the 3-month mortality in this subset (AUC=0.628, P=0.065). In comparison to the AUC of MELD (0.717 for all subjects and 0.695 for those with MELD score ≤30), prognostic accuracy was increased in the iMELD and MELD-Na (P<0.05 for all), decreased in the MELD-XI, and remained equivalent in the UKMELD and upMELD models (Table IV and Fig. 1A and C).


Prognostic performance of a series of model for end-stage liver disease and respective Δ scores in patients with hepatitis B acute-on-chronic liver failure.

Xun YH, Shi JP, Li CQ, Li D, Shi WZ, Pan QC, Guo JC, Zang GQ - Mol Med Rep (2014)

Comparison of area under receiver operating characteristic (ROC) curves (AUC) for model for end-stage liver disease (MELD) and respective delta scores for the 3-month mortality assessment in acute-on-chronic hepatitis B liver failure (ACHBLF) patients with different characteristics. (A,B) all, (C,D) MELD score ≤30, (E,F) treated with antivirals, and (G,H) not treated with antivirals. For an explanation of MELD models, see previous tables.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4020485&req=5

f1-mmr-09-05-1559: Comparison of area under receiver operating characteristic (ROC) curves (AUC) for model for end-stage liver disease (MELD) and respective delta scores for the 3-month mortality assessment in acute-on-chronic hepatitis B liver failure (ACHBLF) patients with different characteristics. (A,B) all, (C,D) MELD score ≤30, (E,F) treated with antivirals, and (G,H) not treated with antivirals. For an explanation of MELD models, see previous tables.
Mentions: The AUC was estimated to be >0.5 for all progostic models (0.647–0.807, P<0.05 for all) applied on all subjects; this value corresponds to a consistently appropriate sensitivity and specificity. The iMELD score had the highest AUC of 0.807 (95% CI, 0.71–0.905) with a sensitivity of 71.7% and a specificity of 84.6% for an optimal cut-off value of 41.5. It was followed by MELD-Na, UKMELD, MELD, upMELD and MELD-XI in terms of performance. Similar results were observed when model scores were compared at the same cut-off value and patients with MELD score >30 were excluded, with only MELD-XI failing to predict the 3-month mortality in this subset (AUC=0.628, P=0.065). In comparison to the AUC of MELD (0.717 for all subjects and 0.695 for those with MELD score ≤30), prognostic accuracy was increased in the iMELD and MELD-Na (P<0.05 for all), decreased in the MELD-XI, and remained equivalent in the UKMELD and upMELD models (Table IV and Fig. 1A and C).

Bottom Line: In each pair of models, the ∆ score was superior to its counterpart, particularly when applied to patients with MELD ≤ 30.Decreased accuracy was observed for all models in the subset of patients treated with antivirals, although their baseline characteristics were comparable to those of untreated patients, while iMELD, MELD-Na and respective ∆ models remained superior with regard to the predictability.The iMELD and MELD-Na models predicted three-month mortality more accurately, while the ∆ models were superior to their counterparts when MELD ≤ 30; however, their performance was altered by antivirals, and thus requires optimization.

View Article: PubMed Central - PubMed

Affiliation: Department of Liver Diseases, Hangzhou Sixth People's Hospital/Xixi Hospital of Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang 310014, P.R. China.

ABSTRACT
The present study aimed to compare the short-term prognostic performance of a series of model for end-stage liver disease (MELD) and respective delta (∆) scores scoring systems in a population with acute-on-chronic hepatitis B liver failure (ACHBLF), and to investigate the potential effects from antivirals. A total of 77 patients with ACHBLF of mean age 46 years, 82% male, with 58.4% receiving antivirals, were recruited for this study. The ∆ scores for MELDs were defined as the changes one week after admission. Thirty‑eight (49%) patients (22 treated with antivirals) died within three months. The mean MELD and ∆MELD scores of the survival group were 19.5 ± 4.4 and 0.2 ± 3.7 respectively, and those of the mortality group were 23.5 ± 5.5 and 7.9 ± 6, respectively. The area under the receiver operating characteristic curve (AUC) for MELD, integrated MELD (iMELD), MELD with the addition of serum sodium (MELD-Na), updated MELD (upMELD), MELD excluding the international normalized ratio (INR; MELD-XI), United Kingdom MELD (UKMELD) and their ∆ scores were 0.72, 0.81, 0.77, 0.69, 0.65, 0.77 and 0.86, 0.83, 0.83, 0.82, 0.79 and 0.79, respectively. iMELD and MELD-Na significantly improved the accuracy of MELD (P<0.05). A cut-off value of 41.5 for the iMELD score can prognose 71% of mortalities with a specificity of 85%. In each pair of models, the ∆ score was superior to its counterpart, particularly when applied to patients with MELD ≤ 30. Decreased accuracy was observed for all models in the subset of patients treated with antivirals, although their baseline characteristics were comparable to those of untreated patients, while iMELD, MELD-Na and respective ∆ models remained superior with regard to the predictability. The iMELD and MELD-Na models predicted three-month mortality more accurately, while the ∆ models were superior to their counterparts when MELD ≤ 30; however, their performance was altered by antivirals, and thus requires optimization.

Show MeSH
Related in: MedlinePlus