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J Gastroenterol Hepatol. 2018 Feb 20. doi: 10.1111/jgh.14128. [Epub ahead of print]
How can we improve the performance of MELDNa score in patients with HBV-related decompensated liver cirrhosis commencing antiviral treatment?Kim TH1, Ku DH1, Um SH1, Lee HA1, Park SW1, Chang JM1, Yim SY1, Suh SJ1, Jung YK1, Seo YS1, Kim JH1, Yim HJ1, Yeon JE1, Byun KS1, Ahn H2.
Author information
1Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.2Department of Medical Statistics, Korea University College of Medicine, Seoul, Korea.
AbstractBACKGROUND AND AIM: We aimed to develop a more efficient prognostic model to predict 1-year mortality in patients with hepatitis B virus (HBV)-related decompensated cirrhosis beginning antiviral treatment.
METHODS: Using Cox regression analysis, survival analyses were performed on 554 patients with decompensated cirrhosis who were followed up from the start of nucleos(t)ide analogue antiviral treatment.
RESULTS: At baseline, ascites and hepatic encephalopathy were found in 78.0% and 18.1% of patients, respectively. Eighty-six events (77 deaths and 9 emergency liver transplants [LTs]) occurred within the first year of treatment. Severity of ascites, presence of hepatic encephalopathy, and the Model for End-Stage Liver Disease (MELD)-sodium (MELDNa) score were independent risk factors for 1-year mortality. The new prognostic model (the revised MELDNa [rMELDNa]) constructed by adding ascites and encephalopathy to the MELDNa score significantly improved the area under the receiver operating characteristics curve for predicting 1-year events at baseline compared with the Child-Turcotte-Pugh (CTP) system, MELD and MELDNa models, and Fontana index (0.905 vs. 0.867, 0.843, 0.871, and 0.815, respectively; P<0.05). Furthermore, repetitive application of rMELDNa at 0, 1, 2, 3, and 6 months of treatment could predict 81.4 % (70/86) of 1-year events, which was significantly (P<0.05) higher than the sensitivity of the CTP system (68.6%), MELD (70.9%) and MELDNa (68.6%) scores, and Fontana index (64.0%), achieving similar specificities of ~96%.
CONCLUSIONS: Ascites and encephalopathy should be considered together with the MELDNa score when predicting short-term mortality and planning LT in patients with decompensated HBV-related cirrhosis starting antiviral treatment.
This article is protected by copyright. All rights reserved.
KEYWORDS: Hepatitis B; Liver cirrhosis; Liver transplantation; Prognosis
PMID:29462844DOI:10.1111/jgh.14128
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