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Yu, Xia (X);Zhou, Ruoqi (R);Tan, Wenting (W);Wang, Xiaobo (X);Zheng, Xin (X);Huang, Yan (Y);Chen, Jinjun (J);Li, Beiling (B);Liu, Xinxin (X);Li, Zhiwei (Z);Meng, Zhongji (Z);Gao, Yanhang (Y);Qian, Zhiping (Z);Liu, Feng (F);Lu, Xiaobo (X);Shang, Jia (J);Yan, Huadong (H);Zheng, Yubao (Y);Zhang, Weituo (W);Yin, Shan (S);Gu, Wenyi (W);Deng, Guohong (G);Xiang, Xiaomei (X);Zhou, Yi (Y);Hou, Yixin (Y);Zhang, Qun (Q);Xiong, Shue (S);Liu, Jing (J);Chen, Ruochan (R);Long, Liyuan (L);Jiang, Xiuhua (X);Luo, Sen (S);Chen, Yuanyuan (Y);Jiang, Chang (C);Zhao, Jinming (J);Ji, Liujuan (L);Mei, Xue (X);Li, Jing (J);Li, Tao (T);Zheng, Rongjiong (R);Zhou, Xinyi (X);Cai, Qun (Q);Li, Hai (H);Sheng, Jifang (J);Shi, Yu (Y); |
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PMID: 39944361 https://pubmed.ncbi.nlm.nih.gov/39944361/
Abstract
BACKGROUND: The model for end-stage liver disease (MELD) score is widely used for the prognostication in end-stage liver disease but has limited performance in acute-on-chronic liver failure (ACLF). In this study, we identified additional predictive parameters and reformed the MELD score to predict ACLF more accurately.
METHODS: A meta-analysis was performed on relevant studies to identify the predictive factors of 28-day/90-day outcomes of ACLF, which were validated in two large prospective cohorts. A prognostic score was developed by incorporating predictive parameters into the MELD score. The model was evaluated with a focus on discrimination and calibration.
RESULTS: The meta-analysis incorporated 32 cohort studies with a total of 13 939 patients, of which 13 risk factors were identified, and 3 risk factors (age, neutrophil count and hepatic encephalopathy (HE) grade) besides MELD score were validated in 751 patients with ACLF derived from two prospective cohorts. A new model (Chinese Acute-on-Chronic Liver Failure Consortium (CATCH-LIFE)-MELD score) was developed as follows: 0.028×age+0.3×HE grade+0.039×neutrophil count+0.079×MELD score. CATCH-LIFE-MELD score achieved a concordance index of 0.791/0.788 for 28-day/90-day outcomes, which is superior to other traditional scores. Other discrimination indices, including net reclassification improvement, integrated discrimination improvement and probability density function, and calibration including Nagelkerke's R and Brier scores confirmed its superiority. Moreover, the accuracy of CATCH-LIFE-MELD score remained stable. It was highest in patients with or without hepatitis B virus infection, cirrhosis, liver failure or under the Chinese Group on the Study of Severe Hepatitis B (COSSH) criteria or European Association for the Study of the Liver (EASL) criteria. All results were substantiated by an evaluation using an external cohort.
CONCLUSIONS: CATCH-LIFE-MELD score, a modified MELD score exhibited improved accuracy in predicting the short-term prognosis of ACLF than other traditional scores.
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