Clinical and prognostic relevance of albumin dimers in patients with cirrhosis: A novel identified structural alteration of the molecule

Abstract

partly improved its performance, but this result requires further confirmation. Aim: To assess the reliability of MELD-Na scores to predict mortality and to identify other independent prognostic factors in patientswithHCV-relatedcirrhosis after thefirst episodeofdecompensation. Patients and methods: The study design is a multicenter prospective cohort that enrolled all consecutive patientswithHCVrelated cirrhosis at the time of first episode of decompensation (Bruno, 2013). In time-to-event analyses, the considered events of interest were death or OLT. Hepatocellular carcinoma (HCC) was considered as a competing event. A direct comparison of a model that includes only MELD-Na score as a covariate and a model that included decompensation characteristic was carried out, as well. To evaluate the incremental predictive information of new disease definition we used the likelihood ratio test (LRT). Results: Two hundreds and two subjects were included in this analysis. Approximately two thirds of patients were men and the mean agewas 60.9 years. The distribution of CTP classeswas: 19.4% inclassA,61.0% inclassB, and19.6% inclassC.Cumulative incidence of failure was 18.2% and 27.9% at 12 and at 18 months, respectively. Median MELD-Na of 13 was considered as reference in the computation of the hazard ratios. Multivariate analysis is shown in Table 1. The 18-months risks of failure predicted by model considering only MELD-Na (Model 1) and by model including also Hb and Age (Model 2) were compared between patients with and without eventa. The continuous net reclassification improvement (NRI) index was 42.6%. Conclusions: In the clinical setting of HCV-related cirrhosis, MELD-Na calculation, with the inclusion of Hb value and age at the time of first decompensation, enhances the value of mortality prediction, thus enabling a better patient allocation for OLT.