A model to predict survival in patients with end-stage liver disease

A recent mandate emphasizes severity of liver disease to determine prioriti es in allocating organs for liver transplantation and necessitates a diseas e severity index based on generalizable, verifiable, and easily obtained va riables. The aim of the study was to examine the generalizability of a mode l previously created to estimate survival of patients undergoing the transj ugular intrahepatic portosystemic shunt (TIPS) procedure in patient groups with a broader range of disease severity and etiology. The Model for End-St age Liver Disease (MELD) consists of serum bilirubin and creatinine levels, International Normalized Ratio (INR) for prothrombin time, and etiology of liver disease. The model's validity was tested in 4 independent data sets, including (1) patients hospitalized for hepatic decompensation (referred t o as "hospitalized" patients), (2) ambulatory patients with noncholestatic cirrhosis, (3) patients with primary biliary cirrhosis (PBC), and (4) unsel ected patients from the 1980s with cirrhosis (referred to as "historical" p atients). In these patients, the model's ability to classify patients accor ding to their risk of death was examined using the concordance (c)-statisti c, The MELD scale performed well in predicting death within 3 months with a c-statistic of (1) 0.87 for hospitalized patients, (2) 0.80 for noncholest atic ambulatory patients, (3) 0.87 for PBC patients, and (4) 0.78 for histo rical cirrhotic patients. Individual complications of portal hypertension h ad minimal impact on the model's prediction (range of improvement in c-stat istic: <.01 for spontaneous bacterial peritonitis and variceal hemorrhage t o ascites: 0.01-0.03), The MELD scale is a reliable measure of mortality ri sk in patients with end-stage liver disease and suitable for use as a disea se severity index to determine organ allocation priorities.