Abstract
The Acute Physiology and Chronic Health Evaluation (APACHE) IV score and Simplified Acute Physiology Score (SAPS) 3 include liver transplantation as a diagnostic category. The performance of APACHE IV-liver transplantation (LT) specific predicted mortality, SAPS 3, APACHE II, Model for End-stage Liver Disease (MELD)-Na, MELD, and CTP scores in predicting in-hospital and 1 year mortality in liver transplant patients was compared using 590 liver transplantations in a single university hospital. In-hospital mortality and 1 year mortality were 2.9% and 4.2%, respectively. The APACHE IV-LT specific predicted mortality showed better performance in predicting in-hospital mortality (AUC 0.91, 95% CI [0.86–0.96]) compared to SAPS 3 (AUC 0.78, 95% CI [0.66–0.90], p = 0.01), MELD-Na (AUC 0.74, 95% CI [0.57–0.86], p = 0.01), and CTP (AUC 0.68, 95% CI [0.54–0.81], p = 0.01). The APACHE IV-LT specific predicted mortality showed better performance in predicting 1 year mortality (AUC 0.83, 95% CI [0.76–0.9]) compared to MELD-Na (AUC 0.67, 95% CI [0.55–0.79], p = 0.04) and CTP (AUC 0.64, 95% CI [0.53–0.75], p = 0.03), and also in all MELD groups and in both living and deceased donor transplantation. The APACHE IV-LT specific predicted mortality showed better performance in predicting in-hospital and 1 year mortality after liver transplantation.
Highlights
Liver transplantation was not incorporated into scores or models until the recently updated APACHE IV and SAPS 3 models[12, 13]
Between October 2010 and September 2014, 633 patients who had undergone living donor or deceased donor liver transplantation were admitted to the surgical ICU
The main findings of this study are that the APACHE IV-LT specific predicted mortality 1) showed very good to excellent discrimination and calibration in predicting in-hospital and 1 year mortality after liver transplantation, 2) showed better discrimination in in-hospital and 1 year mortality compared to other scores, and 3) was the only model that showed good to excellent discrimination in in-hospital and 1 year mortality in all MELD groups and in both living and deceased donor liver transplantation
Summary
Liver transplantation was not incorporated into scores or models until the recently updated APACHE IV and SAPS 3 models[12, 13]. There has been no comparison of APACHE IV and SAPS 3 with other outcome prediction models in patients undergoing liver transplantation. We compared the performance of prognostic models in predicting early mortality in liver transplant patients: APACHE IV-LT specific predicted mortality, SAPS 3, APACHE II, MELD-Na, MELD, and Child-Turcotte-Pugh (CTP) scores. Factors associated with in-hospital mortality after liver transplantation were evaluated. AUC (95% CI) Cutoff point H-L C-test χ2 p-value H-L H-test χ2 p-value SMR (95% CI) Sensitivity Specificity PPV NPV
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
