The Model of Mortality with Incident Cirrhosis (MoMIC) and the model of Long-term Outlook of Mortality in Cirrhosis (LOMiC)


Autoři: Ellen R Berni aff001;  Bethan I Jones aff001;  Thomas R Berni aff001;  James Whitehouse aff002;  Mark Hudson aff003;  James Orr aff003;  Pete Conway aff001;  Bharat Amlani aff002;  Craig J. Currie aff001
Působiště autorů: Global Epidemiology, Pharmatelligence, Cardiff, United Kingdom aff001;  Norgine Pharmaceuticals Limited, Harefield, Uxbridge, United Kingdom aff002;  Liver Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom aff003;  Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom aff004;  Division of Population Medicine, School of Medicine, Cardiff University, United Kingdom aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223253

Souhrn

The purpose of this study was to produce two statistical survival models in those with cirrhosis utilising only routine parameters, including non-liver-related clinical factors that influence survival. The first model identified and utilised factors impacting short-term survival to 90-days post incident diagnosis, and a further model characterised factors that impacted survival following this acute phase. Data were from the Clinical Practice Research Datalink linked with Hospital Episode Statistics. Incident cases in patients ≥18 years were identified between 1998 and 2014. Patients that had prior history of cancer or had received liver transplants prior were excluded. Model-1 used a logistic regression model to predict mortality. Model-2 used data from those patients who survived 90 days, and used an extension of the Cox regression model, adjusting for time-dependent covariables. At 90 days, 23% of patients had died. Overall median survival was 3.7 years. Model-1: numerous predictors, prior comorbidities and decompensating events were incorporated. All comorbidities contributed to increased odds of death, with renal disease having the largest adjusted odds ratio (OR = 3.35, 95%CI 2.97–3.77). Model-2: covariables included cumulative admissions for liver disease-related events and admissions for infections. Significant covariates were renal disease (adjusted hazard ratio (HR = 2.89, 2.47–3.38)), elevated bilirubin levels (aHR = 1.38, 1.26–1.51) and low sodium levels (aHR = 2.26, 1.84–2.78). An internal validation demonstrated reliability of both models. In conclusion: two survival models that included parameters commonly recorded in routine clinical practice were generated that reliably forecast the risk of death in patients with cirrhosis: in the acute, post diagnosis phase, and following this critical, 90 day phase. This has implications for practice and helps better forecast the risk of mortality from cirrhosis using routinely recorded parameters without inputs from specialists.

Klíčová slova:

Alcohol consumption – Ascites – Bilirubin – Cancer detection and diagnosis – Cirrhosis – Diagnostic medicine – Hemorrhage – Liver diseases


Zdroje

1. Neff GW, Duncan CW, Schiff ER. The current economic burden of cirrhosis. Gastroenterol Hepatol (N Y). 2011;7: 661–71.

2. Perz JF, Armstrong GL, Farrington LA, Hutin YJF, Bell BP. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol. 2006;45: 529–38. doi: 10.1016/j.jhep.2006.05.013 16879891

3. Williams R, Aspinall R, Bellis M, Camps-Walsh G, Cramp M, Dhawan A, etal. Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. Lancet. 2014;384: 1953–97. doi: 10.1016/S0140-6736(14)61838-9 25433429

4. Cirrhosis. Available from: http://www.britishlivertrust.org.uk/liver-information/liver-conditions/cirrhosis/

5. Veldt BJ, Lainé F, Guillygomarc'h A, Lauvin L, Boudjema K, Messner M, et al. Indication for liver transplantation in severe alcoholic liver cirrhosis: quantitative evaluation and optimal timing. J Hepatol. 2002;36: 93–98. doi: 10.1016/s0168-8278(01)00228-8 11804670

6. Fleming KM, Aithal GP, Card TR, West J. All-cause mortality in people with cirrhosis compared with the general population: a population-based cohort study. Liver Int. 2012;32: 79–84.

7. Hall P, Cash J. What is the real function of the liver “function” tests? Ulster Med J. 2012;81: 30–6. 23536736

8. Facts About Liver Disease. British Liver Trust. Available from: https://www.britishlivertrust.org.uk/about-us/media-centre/facts-about-liver-disease/

9. Peng Y, Qi X, Guo X. Child-Pugh versus MELD score for the assessment of prognosis in liver cirrhosis: a systematic review and meta-analysis of observational studies. Medicine (Baltimore). 2016;95: e2877.

10. Orrego H, Blake JE, Blendis LM, Medline A. Prognosis of alcoholic cirrhosis in the presence and absence of alcoholic hepatitis. Gastroenterology. 1987;92: 208–214. doi: 10.1016/0016-5085(87)90861-4 3781189

11. Gallagher A, Puri S, Staa T. Linkage of the General Practice Research Database (GPRD) with other data sources. Pharmacoepidemiol Drug Saf. 2011;20: S230.

12. Herrett E, Thomas SL, Schoonen WM, Smeeth L, Hall AJ. Validation and validity of diagnoses in the General Practice Research Database: a systematic review. Br J Clin Pharmacol. 2010;69: 4–14. doi: 10.1111/j.1365-2125.2009.03537.x 20078607

13. R Core Team (2017). R: A. language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/

14. Song X, Zhou X-H. A semiparametric approach for the covariate specific ROC curve with survival outcome. Statistica Sinica. 2008;18: 947–965.

15. Qin Q, Bian Z-L, Shen Y, Zhang L, Zhu X-H, Liu Y-M, et al. Logistic regression model can reduce unnecessary artificial liver support in hepatitis B virus-associated acute-on-chronic liver failure: decision curve analysis. BMC Med Inform Decis Mak. 2016;16: 59. doi: 10.1186/s12911-016-0302-7 27260306

16. Ng CK, Chan MH, Tai MH, Lam CW. Hepatorenal Syndrome. Clinical Biochemist Reviews. 2007;28: 11–17.

17. Mindikoglu AL, Weir MR. Current Concepts in the Diagnosis and Classification of Renal Dysfunction in Cirrhosis. American Journal of Nephrology 2013;38: 345–354. doi: 10.1159/000355540 24107793

18. Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359: 1018–26. doi: 10.1056/NEJMoa0801209 18768945

19. Vinholt PJ, Hvas AM, Frederiksen H, Bathum L, Jørgensen MK, Nybo M. Platelet count is associated with cardiovascular disease, cancer and mortality: A population-based cohort study. Thromb Res. 2016;148:136–142. doi: 10.1016/j.thromres.2016.08.012 27586589

20. Afdhal N, McHutchison J, Brown R, Jacobson I, Manns M, Poordad F, et al. Thrombocytopenia associated with chronic liver disease. J Hepatol.2008;48(6):1000–7. doi: 10.1016/j.jhep.2008.03.009 18433919

21. Kamath PS, Kim WR. The model for end‐stage liver disease (MELD). Hepatology. 2007;45: 797–805. doi: 10.1002/hep.21563 17326206

22. Degré D, Bourgeois N, Boon N, Le Moine O, Louis H, Donckier V, et al. Aminopyrine breath test compared to the MELD and Child-Pugh scores for predicting mortality amount cirrhotic patients awaiting liver transplantation. Transpl Int. 2004; 17:31–38 doi: 10.1007/s00147-003-0655-6 14745489

23. Kartoun U, Corey K, Simon T, Zheung H, Aggarwal R, Ng K, et al. The MELD-Plus: A generalizable prediction risk score in cirrhosis. PLoS One, 2017; 12(10).


Článek vyšel v časopise

PLOS One


2019 Číslo 10

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

Léčba bolesti v ordinaci praktického lékaře
nový kurz
Autoři: MUDr. PhDr. Zdeňka Nováková, Ph.D.

Revmatoidní artritida: včas a k cíli
Autoři: MUDr. Heřman Mann

Jistoty a nástrahy antikoagulační léčby aneb kardiolog - neurolog - farmakolog - nefrolog - právník diskutují
Autoři: doc. MUDr. Štěpán Havránek, Ph.D., prof. MUDr. Roman Herzig, Ph.D., doc. MUDr. Karel Urbánek, Ph.D., prim. MUDr. Jan Vachek, MUDr. et Mgr. Jolana Těšínová, Ph.D.

Léčba akutní pooperační bolesti
Autoři: doc. MUDr. Jiří Málek, CSc.

Nové antipsychotikum kariprazin v léčbě schizofrenie
Autoři: prof. MUDr. Cyril Höschl, DrSc., FRCPsych.

Všechny kurzy
Kurzy Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Nemáte účet?  Registrujte se

Zapomenuté heslo

Zadejte e-mailovou adresu se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se