title: A Karnofsky performance status-based score predicts death after hospital discharge in patients with cirrhosis.
abstract: Identification of patients with cirrhosis at risk for death within 3 months of discharge from the hospital is essential to individualize postdischarge plans. The objective of the study was to identify an easy-to-use prognostic model based on the Karnofsky Performance Status (KPS). The North American Consortium for the Study of End-Stage Liver Disease consists of 16 tertiary-care hepatology centers that prospectively enroll nonelectively admitted cirrhosis patients. Patients enrolled had KPS assessed 1 week postdischarge. KPS was categorized into low (score 10-40), intermediate (50-70), and high (80-100). Of 954 middle-aged patients (57 ± 10 years, 63% men) with a median Model for End-Stage Liver Disease (MELD) score of 17 (interquartile range 13-21), the mortality rates for the low, intermediate, and high performance status groups were 23% (36/159), 11% (55/489), and 5% (15/306), respectively. Low, intermediate, and high performance status was seen in 17%, 51%, and 32% of the cohort, respectively. Low performance status was associated with older age, dialysis, hepatic encephalopathy, longer length of stay, and higher white blood cell count or MELD score at discharge. A model was derived using the three independent predictors of 3-month mortality: KPS, age, and MELD score. This score had better discrimination (area under the receiver operating characteristic curve = 0.74) than a model using MELD (area under the receiver operating characteristic curve = 0.62) or MELD and age (area under the receiver operating characteristic curve = 0.67) to predict 3-month mortality.
  
  
  
  Cirrhosis patients at risk for 3-month postdischarge mortality can be identified using a novel KPS-based score; this score may be adopted in practice to guide postdischarge early interventions, including the integrated provision of active and palliative management strategies. (Hepatology 2017;65:217-224).
authors: University of Alberta, Edmonton, AB, Canada.
authors: Puneeta
authors: P
authors: Tandon
authors: University of Pennsylvania, Philadelphia, PA.
authors: K Rajender
authors: KR
authors: Reddy
authors: Baylor University Medical Center, Dallas, TX.
authors: Jacqueline G
authors: JG
authors: O'Leary
authors: Yale University, New Haven, CT.
authors: Guadalupe
authors: G
authors: Garcia-Tsao
authors: University of Alberta, Edmonton, AB, Canada.
authors: Juan G
authors: JG
authors: Abraldes
authors: University of Toronto, Toronto, ON, Canada.
authors: Florence
authors: F
authors: Wong
authors: University of Colorado, Denver, CO.
authors: Scott W
authors: SW
authors: Biggins
authors: University of Rochester, Rochester, NY.
authors: Benedict
authors: B
authors: Maliakkal
authors: University of Texas, Houston, TX.
authors: Michael B
authors: MB
authors: Fallon
authors: Emory University, Atlanta, GA.
authors: Ram M
authors: RM
authors: Subramanian
authors: Mercy Medical Center, Baltimore, MD.
authors: Paul
authors: P
authors: Thuluvath
authors: Mayo Clinic, Rochester, MN.
authors: Patrick S
authors: PS
authors: Kamath
authors: Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA.
authors: Leroy R
authors: LR
authors: Thacker
authors: Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA.
authors: Jasmohan S
authors: JS
authors: Bajaj
mesh_terms: D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008103:Liver Cirrhosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010351:Patient Discharge; D011379:Prognosis; D011446:Prospective Studies