Can the model for end-stage liver disease be used to predict the prognosis in patients with Budd-Chiari syndrome?
The model for end-stage liver disease (MELD) is a widely accepted and objective scoring system for end-stage liver disease (ESLD) but has never been evaluated for Budd-Chiari syndrome (BCS). We investigated whether MELD can be used to predict survival in patients with BCS. Patients with BCS (n = 237) were obtained from a large international study. Patients with ESLD (n = 281) were used to compare the discriminative ability of MELD in BCS versus other chronic liver diseases. MELD and the Rotterdam BCS index, a recently developed prognostic index for BCS, were calculated with standard equations. Receiver operating characteristic curves and concordance statistics (c-statistics) were used to assess the models' ability to predict 1-year survival. The median MELD score was 12.5 (range = -7.4 to 43.4) for BCS and 11.3 (-3.0 to 49.5) for ESLD (P = 0.12). The c-statistic of MELD in BCS was 0.695 [95% confidence interval (CI) = 0.59-0.80], in contrast to 0.848 (95% CI = 0.80-0.90) in ESLD. Survival was significantly poorer in ESLD than in BCS (P < 0.001). The c-statistic of the Rotterdam BCS index was 0.760 (95% CI = 0.67-0.85). The correlation between MELD and the Rotterdam BCS index was 0.61, and most of the discrepancy existed in BCS patients with a high prevalence of ascites and encephalopathy and preserved liver function. The addition of ascites and encephalopathy to MELD improved the c-statistic to 0.751 (95% CI = 0.65-0.85). In conclusion, MELD showed a suboptimal discriminative ability to predict survival in BCS. This was explained by the highly variable degree of liver dysfunction and hence clinical outcome in BCS in contrast to ESLD.
Darwish Murad
Sarwa
S
Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
Kim
W Ray
WR
de Groen
Piet C
PC
Kamath
Patrick S
PS
Malinchoc
Michael
M
Valla
Dominique-Charles
DC
Janssen
Harry L A
HL
D000293:Adolescent; D000328:Adult; D000368:Aged; D006502:Budd-Chiari Syndrome / Q000175:diagnosis*; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index