Model for end-stage liver disease-sodium underestimates 90-day mortality risk in patients with acute-on-chronic liver failure.

Journal of Hepatology
Ruben HernaezFasiha Kanwal

Abstract

It is unclear whether the model for end-stage liver disease-sodium (MELD-Na) score captures the clinical severity of acute-on-chronic liver failure (ACLF). We compared observed 90-day mortality in patients with ACLF with expected mortality based on the calculated MELD-Na and examined the consequences of underestimating clinical severity. We identified patients with ACLF during hospitalization for cirrhosis in 127 VA hospitals between 01/01/2004 and 12/31/2014. We examined MELD-Na scores by ACLF presence and grade. We used actual and observed 90-day mortality to estimate a standardized mortality ratio (SMR) by ACLF presence and grade. We used transplant center-specific median MELD-Na at transplantation (MMaT) to estimate the proportion likely to receive priority for liver transplantation (LT) based on MELD-Na alone. Of 71,894 patients hospitalized for decompensated cirrhosis, 18,979 (26.4%) patients met the criteria for ACLF on admission. The median (P25-P75) MELD-Na on admission was 26 (22-30) for ACLF compared to 15 (12-20) for patients without ACLF; it was 24 (21-27), 27 (23-31), and 32 (26-37) for ACLF-1, 2 and 3, respectively. At 90 days, 40.0% of patients with ACLF died (30.8%, 41.6% and 68.8% with ACLF-1, 2 and 3, respect...Continue Reading

References

Jan 5, 2005·Journal of Hepatology·Richard B Freeman
Sep 5, 2008·The New England Journal of Medicine·W Ray KimTerry M Therneau
Mar 12, 2013·Gastroenterology·Richard MoreauUNKNOWN CANONIC Study Investigators of the EASL–CLIF Consortium
Apr 10, 2014·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Paul MartinMichael Fallon
Jun 21, 2014·Journal of Hepatology·Rajiv JalanUNKNOWN CANONIC study investigators of the EASL-CLIF Consortium
Apr 17, 2015·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Thierry GustotUNKNOWN CANONIC Study Investigators of the EASL-CLIF Consortium
Jul 19, 2015·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·David E KaplanUNKNOWN VOCAL Study Group
Mar 19, 2016·Journal of Hepatology·X ArizaUNKNOWN CANONIC Investigators, EASL CLIF Consortium
Jan 6, 2017·Gut·Ruben HernaezPere Ginès
Sep 16, 2017·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Louise ChinaAlastair O'Brien
Jan 10, 2018·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Jacqueline G O'LearyJasmohan S Bajaj
Feb 3, 2018·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Salvatore PianoUNKNOWN EASL CLIF Consortium, European Foundation for the Study of Chronic Liver Failure (EF Clif)
May 1, 2018·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Jonathan RiceScott W Biggins
Jan 8, 2019·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Nadim MahmudDavid S Goldberg
Jun 7, 2019·Hepatology International·Shiv Kumar SarinUNKNOWN APASL ACLF Research Consortium (AARC) for APASL ACLF working Party.
Feb 18, 2020·Journal of Hepatology·Markus TriebRudolf E Stauber
May 18, 2020·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Ruben HernaezHugo R Rosen

❮ Previous
Next ❯

Citations

Nov 19, 2020·Journal of Personalized Medicine·Cheng-Yueh LuRey-Heng Hu
May 18, 2021·JHEP Reports : Innovation in Hepatology·Savneet KaurShiv K Sarin
Nov 20, 2020·Transplantation·Constantine J KarvellasEmmanuel Weiss
Jun 26, 2021·Journal of Hepatology·Rajiv JalanWilliam Bernal
Jun 27, 2021·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Ben F J GoudsmitHein Putter
Jun 14, 2021·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Thomas G Cotter, Vinay Sundaram
Oct 9, 2021·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Vinay Sundaram, Rajiv Jalan
Jan 1, 2022·Expert Opinion on Drug Discovery·Sven LamatschCornelius Engelmann
Jan 11, 2022·The American Journal of Gastroenterology·Jasmohan S BajajPatrick S Kamath
Jan 15, 2022·Journal of Hepato-biliary-pancreatic Sciences·Chunhua HuYingli He

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.