Survival prediction among patients with non-cancer-related end-stage liver disease

Yi Wen Tsai, I. Shiang Tzeng, Yi Chuan Chen, Tsung Han Hsieh, Shy Shin Chang

Research output: Contribution to journalArticle

Abstract

Background Predicting the survival of non-cancer related end-stage-liver-disease patients in general practice has been difficult for physicians because of the extremely variable trajectories due to multiple complex clinical factors, hence it remains a challenging issue to date. This study aimed to develop and validate a specific prognostic scoring system to early recognize the prognosis and improve the quality of end-of life care for non-cancer end-stage-liver-disease population. Materials and methods A multicentre, retrospective cohort study was conducted during January 2010 ~ December 2012 and continued follow-up until December 2014. A cox proportional hazard regression analysis was used to derive and validate an optimized model. The main outcome measures were the 28-day, 3-month, 6-month, and 12-month mortality prediction. The performance of the novel model was evaluated, including discrimination and calibration. Results A total of 4,080 consecutive subjects were enrolled. The AUROCs for the 3-month survival discrimination in the MELD, MELD-Na and novel model were 0.787, 0.705 and 0.804 (P<0.001); the 6-month survival discrimination were 0.781, 0.702 and 0.797 (P<0.001); the overall survival discrimination were 0.771, 0.694 and 0.785 (P = 0.002) respectively, whereas the novel model showed a significantly higher discrimination power than did the MELD and MELD-Na for the 3-month, 6-month and overall survival prediction. In addition, calibration of external validation cohort showed no statistical difference in all 5 groups compared with the observed groups. Conclusion This is a clinically relevant, validated scoring system that can be used sequentially to stratify the prognosis in non-cancer cirrhotic populations, which may help the patients along with medical team in decision making to improve the quality of end-of-life care.

Original languageEnglish
Article numbere0202692
JournalPLoS One
Volume13
Issue number9
DOIs
Publication statusPublished - Sep 1 2018

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End Stage Liver Disease
liver diseases
Liver
prediction
Survival
Terminal Care
prognosis
calibration
Calibration
Quality of Life
cohort studies
physicians
Regression analysis
trajectories
decision making
Hazards
regression analysis
General Practice
Decision making
Trajectories

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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Survival prediction among patients with non-cancer-related end-stage liver disease. / Tsai, Yi Wen; Tzeng, I. Shiang; Chen, Yi Chuan; Hsieh, Tsung Han; Chang, Shy Shin.

In: PLoS One, Vol. 13, No. 9, e0202692, 01.09.2018.

Research output: Contribution to journalArticle

Tsai, Yi Wen ; Tzeng, I. Shiang ; Chen, Yi Chuan ; Hsieh, Tsung Han ; Chang, Shy Shin. / Survival prediction among patients with non-cancer-related end-stage liver disease. In: PLoS One. 2018 ; Vol. 13, No. 9.
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abstract = "Background Predicting the survival of non-cancer related end-stage-liver-disease patients in general practice has been difficult for physicians because of the extremely variable trajectories due to multiple complex clinical factors, hence it remains a challenging issue to date. This study aimed to develop and validate a specific prognostic scoring system to early recognize the prognosis and improve the quality of end-of life care for non-cancer end-stage-liver-disease population. Materials and methods A multicentre, retrospective cohort study was conducted during January 2010 ~ December 2012 and continued follow-up until December 2014. A cox proportional hazard regression analysis was used to derive and validate an optimized model. The main outcome measures were the 28-day, 3-month, 6-month, and 12-month mortality prediction. The performance of the novel model was evaluated, including discrimination and calibration. Results A total of 4,080 consecutive subjects were enrolled. The AUROCs for the 3-month survival discrimination in the MELD, MELD-Na and novel model were 0.787, 0.705 and 0.804 (P<0.001); the 6-month survival discrimination were 0.781, 0.702 and 0.797 (P<0.001); the overall survival discrimination were 0.771, 0.694 and 0.785 (P = 0.002) respectively, whereas the novel model showed a significantly higher discrimination power than did the MELD and MELD-Na for the 3-month, 6-month and overall survival prediction. In addition, calibration of external validation cohort showed no statistical difference in all 5 groups compared with the observed groups. Conclusion This is a clinically relevant, validated scoring system that can be used sequentially to stratify the prognosis in non-cancer cirrhotic populations, which may help the patients along with medical team in decision making to improve the quality of end-of-life care.",
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