alexa Short-term Survival in Acutely Decompensated Cirrhotic Patients
ISSN: 2167-0889

Journal of Liver
Open Access

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Research Article

Short-term Survival in Acutely Decompensated Cirrhotic Patients

Angels Escorsell1,2*, Ferran Torres2,3, Vega Catalina M4, Antoni Mas1,2, José Rios2,3 and Mònica Guevara1,2
1Liver Unit, Hospital Clinic, Spain
2Institute for Biomedical Research August Pi Sunyer (IDIBAPS), University of Barcelona, Spain
3Statistics and Methodology Support Unit, Hospital Clinic, Barcelona, Spain
4Department of Gastroenterology, Hospital Gregorio Maranon, Madrid, Spain
*Corresponding Author : Angels Escorsell
ICU-Liver Unit, IMDM, Hospital Clinic
Villarroel, 17008036 Barcelona, Spain
Tel: 34 932275400 (2591)
Fax: 34 932279348
E-mail: [email protected]
Received: January 14, 2016; Accepted: March 01, 2016; Published: March 07, 2016
Citation: Escorsell A, Torres F, Catalina MV, Mas A, Rios J, et al. (2016) Short-term Survival in Acutely Decompensated Cirrhotic Patients. J Liver 5:194. doi:10.4172/2167-0889.1000194
Copyright: © 2016 Escorsell A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
 

Abstract

Aim: The present study was aimed at the early identification of the prognostic factors for 30-day mortality in acutely decompensated cirrhotic patients. Methods: Logistic regression models were used to study the predictors of mortality. Variables significant on univariate testing were included for the multivariate analysis. ROC curves were constructed. The model used retrospective data from 228 patients; and was prospectively validated among 64 patients from the Hospital Clinic: internal validation and 90 patients from Hospital Gregorio Maranon: external validation. Results: The model identified age at admission, serum concentrations of bilirubin, creatinine and sodium, and INR obtained 2 to 8 days after admission as predictors of death in this population. The resulting risk score was highly accurate: AUROC: 0.9150, 95%CI: 0.8509-0.9790 also in the internal and external validation series, but not better that the most widely used scores in hepatology: MELD: 0.8335, 95%CI: 0.7486-0.9184, MELD-Na: 0.8565, 95%CI: 0.7774-0.9356, iMELD: 0.8972, 95%CI: 0.8297-0.9648 and MESO Index: 0.8464, 95%CI: 0.7656-0.9272. The cutoff levels: LR+, LR- of the new score, MELD and MELD-Na that best predicted 30 days mortality were -0.09: 38.6, 0.51, 28: 16.7, 0.42 and 47: 12, 0.7, respectively. Conclusions: MELD, as well as new, more complicated and scanty used scores, obtained 2 to 8 days after admission allows the early and easy identification of patients with an acute decompensation of cirrhosis at high-risk of death on short-term follow-up. These scores may represent a useful tool to select the population suitable for studies to evaluate the efficacy of new therapies and stratify patients in randomized trials.

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