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MELD score change at 2 weeks predicted patient outcomes

Patients with acute-on-chronic liver failure with an improved model for end-stage liver disease score more than 2 weeks after disease onset had a decreased risk for mortality after 60 days, according to study data.

“In acute-on-chronic liver failure, there is rapid clinical deterioration causing high mortality,” Rajneesh Kumar, MD, MBBS, MRCP, department of gastroenterology and hepatology, Singapore General Hospital, told Healio.com/Hepatology. “There is always a difficult decision to decide when to send the patients for liver transplant, especially when the availability of the donor is scarce. This is the one study which gives a time frame for the clinicians to decide at what point to consider transplant.”

Rajneesh Kumar

Using data from inpatient discharge summaries of 53 patients with underlying chronic liver disease admitted to Singapore General Hospital between January 2001 and April 2013, Kumar and colleagues calculated model for end-stage liver disease scores at 1, 2 and 4 weeks after diagnosis of acute-on-liver failure to determine whether changes in score would predict mortality or the need for liver transplantation. The mean age of the patients was 55.9 years; 73.6% were men.

The greater the improvement in MELD score, the higher the specificity became for predicting transplantation and mortality, the researchers wrote. At 1 week, when MELD score increased or remained the same, a sensitivity of 75% (95% CI, 53.3-90.2) and 20.7% specificity (95% CI, 8.1-39.7) was observed for predicting transplant or mortality, which showed poor sensitivity and specificity. At 2 weeks, if MELD score increased or remained the same, sensitivity was 95.8% (95% CI, 78.8-99.3) and specificity was 51.7% (95% CI, 32.5-70.5) for predicting transplantation or mortality; the negative predictive value was 93.8%.

Further analysis showed that a MELD score that improved at 2 weeks was a strong predictor for survival at 60 days. Overall, 20 patients died and four underwent liver transplantation by 60 days after presentation.

“If the MELD score improves at 2 weeks, the outcome is good; however, if the MELD deteriorates at 2 weeks, there is need for prioritizing liver transplant,” Kumar said. “This study is important as in the past a lot of work has been on prognostic factors, but the time frame at which there is change in the outcome has not been studied well.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.