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Model comparable to MELD in predicting pregnancy-specific liver disease mortality

A logistic model based only on total bilirubin and international normalized ratio can predict mortality among women with pregnancy-specific liver disease almost as successfully as MELD score, a study found.

“Although clinical factors such as encephalopathy and ascites confer a poor outcome, our study results highlight the role of hyperbilirubinemia and increased INR [international normalized ratio] as significant factors in mortality in PsLD [pregnancy-specific liver disease],” the study concluded. “Our study attempts to bridge the unmet needs for assessing the severity of the disease.”

The retrospective study analyzed clinical, hematologic and biochemical data from 130 consecutive patients with PsLD from 2000 to 2011 in India. Patients were followed until death or three months after delivery.

The study found 24.6% of patients (n=32) died, and 24.2% of patients with a MELD score of 20 to 29 died within 1 month of admission. The percentage of patients who died within 1 month of admission increased as MELD score increased: 45.45% of those with a score of 30 to 39 and 90.9% for those with a score of 40 or greater.

The researchers used univariate analysis to determine encephalopathy, ascites, serum total protein, bilirubin, platelet count, alkaline phosphatase, serum creatinine and INR were significant predictive variables.

Multivariate logistic regression found objective predictors of mortality in total bilirubin (adjusted odds ratio=1.165; 95% CI, 1.08-1.26) and INR (aOR=2.091; 95% CI, 1.24-3.52).

Using the new model, 89% of patients with a score of 30 or greater died within 1 month of admission, 48.1% of those who scored 20 to 29 and 21.2% of those with a score of 10 to 19.

“Our study showed that both the MELD scoring system and our simplified de novo model with two objective variables … are reliable methods for predicting the short-term mortality in patients with PsLD,” the authors concluded. “Further prospective studies across other geographic regions are needed to evaluate these models to predict the outcome in patients with PsLD.”

Disclosure: The researchers report no relevant financial disclosures.