title: Occurrence of cirrhosis-related complications is a time-dependent prognostic predictor independent of baseline model for end-stage liver disease score.
abstract: BACKGROUND
  The model for end-stage liver disease (MELD) is used to prioritize cirrhotic patients awaiting liver transplantation. Many cirrhosis-related complications are indications for transplantation but are not included in MELD. This study investigated the impact of these complications on survival and association with MELD.
  
  
  METHODS
  The mortality risk of cirrhosis-related complications, including bleeding esophageal varices, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome and hepatic decompensation, was analyzed using a time-dependent Cox regression model in 227 cirrhotic patients.
  
  
  RESULTS
  A total of 281 episodes of complications occurred in 142 (63%) patients. Patients who died had a significantly higher baseline MELD score compared with those who survived (14.5 +/- 4.5 vs 12.8 +/- 3.9, P = 0.004). There was no significant difference in the MELD score between patients with and without the occurrence of complications (13.6 +/- 4.3 vs 12.9 +/- 4.0, P = 0.093). Patients with a higher baseline MELD score tended to develop early complications (rho = -0.598, P< 0.001). Using the Cox regression model, the risk ratio of mortality was 4.9 (95% confidence interval: 3.9-6.3, P< 0.0001) for each additional episode of complication.
  
  
  CONCLUSIONS
  The mortality risk increases as the number of complication episodes increases. While patients with repeated complications have a poor outcome, they do not necessarily have a higher baseline MELD score and could be down-staged in the MELD era.
authors.affiliation: National Yang-Ming University School of Medicine, Taipei, Taiwan, China. tihuo@vghtpe.gov.tw
authors.forename: Teh-Ia
authors.initials: TI
authors.lastname: Huo
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Fa-Yauh
authors.initials: FY
authors.lastname: Lee
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Hou
authors.forename: Pui-Ching
authors.initials: PC
authors.lastname: Lee
authors.forename: Jaw-Ching
authors.initials: JC
authors.lastname: Wu
authors.forename: Full-Young
authors.initials: FY
authors.lastname: Chang
authors.forename: Shou-Dong
authors.initials: SD
authors.lastname: Lee
mesh_terms: D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality / Q000473:pathology*; D017093:Liver Failure / Q000209:etiology* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome