Occurrence of cirrhosis-related complications is a time-dependent prognostic predictor independent of baseline model for end-stage liver disease score
Version of Record online: 6 OCT 2005
Volume 26, Issue 1, pages 55–61, February 2006
How to Cite
Huo, T.-I., Lin, H.-C., Lee, F.-Y., Hou, M.-C., Lee, P.-C., Wu, J.-C., Chang, F.-Y. and Lee, S.-D. (2006), Occurrence of cirrhosis-related complications is a time-dependent prognostic predictor independent of baseline model for end-stage liver disease score. Liver International, 26: 55–61. doi: 10.1111/j.1478-3231.2005.01190.x
- Issue online: 31 OCT 2005
- Version of Record online: 6 OCT 2005
- Received 13 May 2005, accepted 25 July 2005
- esophageal varices;
- hepatic encephalopathy;
- liver cirrhosis;
- liver transplantation;
- spontaneous bacterial peritonitis
Abstract: 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.