Abstract
Although Model for End-Stage Liver Disease (MELD) score is adopted worldwide for liver transplant allocation, but it has prognostic limitations. The aim of this study was to apply the survival tree analysis to evaluate interaction between variables related to mortality in cirrhotics patients enlisted for liver transplantation, and to develop a new mortality predictive score. Demographic, clinical and laboratory data of cirrhotic patients waiting for liver transplantation during a 12-year period were considered. Charts from 765 patients were reviewed. The interaction between prognostic covariates was obtained using a survival tree analysis. In order to develop the predictive score, Cox regression analysis was performed applying significant data obtained by the survival tree analysis. The prognostic covariates evaluated in the survival tree were MELD score, Child-Pugh score, serum sodium, viral disease etiology, hepatocellular carcinoma diagnosis and generated a coefficient for each. Based on the survival tree analysis, MELD = 15 was the primary root variable (p<0.001). The survival tree provided eight prognostic groups. The higher mortality hazard ratio (HR) risk was observed in the MELD >28 group (HR= 16.7). The new score (Survival Tree Score – STS) was obtained according to the coefficients provided. The STS prognostic performance was superior to MELD score (AUROC 0.713 vs 0.653, p<0.001). STS, could be a useful tool to accurately identify individual mortality risk in advanced liver disease.
Highlights
There is a worldwide deficit of liver organs compared to the number of patients enlisted for liver transplantation
The aim of this study was to apply a Survival Tree Analysis to identify the interaction between variables associated to mortality in cirrhotic patients enlisted for liver transplantation, and to develop a severity score based on this analysis
Data from 765 cirrhotic patients enlisted for liver transplantation at Federal University of Rio de Janeiro, from November 1998 to September 2012 were analyzed
Summary
There is a worldwide deficit of liver organs compared to the number of patients enlisted for liver transplantation. This has led to a constant effort to identify sicker patients waiting for the surgery (HUO et al, 2008; DUTKOWSKI et al, 2011; NORTHUP et al, 2015). MELD (Model for End-stage Liver Disease) score has been adopted to classify sicker patients for liver allocation in many countries.
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