Hepatic encephalopathy and spontaneous bacterial peritonitis improve cirrhosis outcome prediction: A modified seven-stage model as a clinical alternative to MELD

Chien Hao Huang, Hsiao Jung Tseng, Piero Amodio, Yu Ling Chen, Sheng Fu Wang, Shang Hung Chang, Sen Yung Hsieh*, Chun Yen Lin

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

4 Scopus citations

Abstract

Classification of cirrhosis based on clinical stages is rapid and based on five stages at present. Two other relevant events, hepatic encephalopathy (HE) and spontaneous bacterial peritonitis (SBP), can be considered in a clinical perspective but no study has implemented a sevenstage classification and confirmed its value before. In addition, long-term validation of the Model for End-Stage Liver Disease (MELD) in large cohorts of patients with cirrhosis and comparison with clinical findings are insufficient. Therefore, we performed a study to address these items. From the Chang-Gung Research Database (CGRD), 20, 782 patients with cirrhosis were enrolled for an historical survival study. The MELD score, the five-stage clinical score (i.e., occurrence of esophageal varices (EV), EV bleeding, ascites, sepsis) and a novel seven-stage clinical score (i.e., occurrence of EV, EV bleeding, ascites, sepsis, HE, SBP) were compared with their Cox models by receiver operating characteristic (ROC) analysis. The addition of HE and SBP to the seven-stage model had a 5% better prediction result than the five-stage model did in the survival ROC analysis. The result showed that the seven clinical stages are associated with an increased risk for mortality. However, the predicted performances of the seven-stage model and MELD system are likely equivalent. In conclusion, the study (i) proved that clinical staging of cirrhosis based on seven items/stages had higher prognostic value than the five-stage model and (ii) confirmed the validity of the MELD criteria vs. clinical assessment.

Original languageEnglish
Article number186
Pages (from-to)1-13
Number of pages13
JournalJournal of Personalized Medicine
Volume10
Issue number4
DOIs
StatePublished - 12 2020

Bibliographical note

Publisher Copyright:
© 2020 by the authors.

Keywords

  • Cirrhosis
  • Clinical stage models
  • Hepatic encephalopathy
  • MELD
  • Overall mortality
  • Spontaneous bacterial peritonitis

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