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Journal ArticleDOI

Ability of King's College Criteria and Model for End-Stage Liver Disease Scores to Predict Mortality of Patients With Acute Liver Failure: A Meta-analysis

01 Apr 2016-Clinical Gastroenterology and Hepatology (Clin Gastroenterol Hepatol)-Vol. 14, Iss: 4, pp 516-525
TL;DR: Based on a meta-analysis of studies, the KCC more accurately predicts hospital mortality among patients with AALF, whereas MELD scores more accurately predict mortalityamong patients with NAALF.
About: This article is published in Clinical Gastroenterology and Hepatology.The article was published on 2016-04-01 and is currently open access. It has received 91 citations till now. The article focuses on the topics: King's College Criteria & Model for End-Stage Liver Disease.

Summary (2 min read)

Jump to: [INTRODUCTION][METHODS][NAALF).][RESULTS][DISCUSSION] and [OLT.]

INTRODUCTION

  • Acute Liver Failure (ALF) is a rare, but devastating illness with a high risk of progression to multi-organ failure and death1-3.
  • The key clinical issue remains to accurately identify patients with ALF who will die without ELT, and those who will survive with medical management alone.
  • One particularly salient difference is the treatment of transplanted patients.
  • To date, there have been three meta-analyses23 of the performance of the KCC in ALF.
  • The first included only Acetaminophen-induced ALF (AALF) identifying nine studies in total, and concluded that the KCC had limited sensitivity13.

METHODS

  • All potential articles were assessed independently by two researchers (HF, MM) according to prospectively defined eligibility criteria, and disagreements were resolved by consensus or consultation with a third author (WB).
  • If this was not possible or there was doubt over the 2 x 2 calculation, the study was excluded from the subsequent analysis.
  • The DerSimonian-Laird random effects method was used to produce summary estimates of sensitivity, specificity, likelihood ratios (LR) and diagnostic odds ratio (DOR, defined as the ratio of positive to negative likelihood ratios).

NAALF).

  • A funnel plot and effective sample size (ESS) regression analysis (the logarithm of the DOR plotted against 1/√ESS) was used to investigate publication bias.
  • Data analyses were performed using the freeware Meta-Disc version 1.4 (Universidad Complutense, Madrid, Spain) and Eggers statistic calculated in Excel (Microsoft Corporation, Redmond WA)33.

RESULTS

  • The search strategy identified 4,063 potentially relevant studies.
  • Subgroup analysis was performed to assess differences in heterogeneity and diagnostic accuracy between the groups specified earlier.
  • Furthermore Egger's statistic was not significant again suggesting publication bias was not present.

DISCUSSION

  • This meta-analysis confirms that when comparing KCC and MELD for outcome prediction in ALF KCC have lower sensitivity and MELD lower specificity.
  • The sROC analysis is therefore a more valid way to pool the results of studies with varying thresholds.
  • This is no doubt a consequence of the fact that the KCC were derived from an ALF cohort, whereas MELD was developed from results in chronic liver disease patients undergoing TIPS.
  • This may be why KCC is preferred in countries facing such organ shortages and with high rates of AALF.
  • Clearly such delays are relatively short but in cases of fulminant hepatic failure it is clearly advantageous to use simpler bedside tests during the evolution of disease.

OLT.

  • Information on prothrombin time measurements and assay details were not available in all studies and may have contributed to heterogeneity or threshold effects.
  • The potential benefits of combining the specificity of the KCC with the sensitivity of MELD are attractive.
  • Such novel methods would require data for each patient rather than summative as presented for publication.
  • Many new biomarkers have been proposed in ALF but have failed to be validated in larger studies or are deemed not ready for widespread distribution.
  • Neither KCC nor MELD are optimal in all circumstances so there remains an urgent need for more accurate outcome prediction systems in ALF.

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Citations
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Book ChapterDOI
01 Jan 2019
TL;DR: This chapter describes the factors involved in the disease prognosis, parameters of outcome evaluations, principles and techniques for progression prevention, and the roles of cell apoptosis, liver regeneration and immunological parameters in assessing patient prognosis.
Abstract: This chapter describes the factors involved in the disease prognosis, parameters of outcome evaluations, principles and techniques for progression prevention. In last section, the future perspectives in both basic and clinical investigations towards unmet medical needs in AECHB and HBV ACLF are discussed. 1. Factors affecting the prognosis of patients with severe hepatitis B include those related to the virus (including viral load, HBeAg expression, and gene mutation), patient age, co-morbidity, TBil, INR, serum Cr, and the host genetic background. Indicators associated with patient prognosis include TBil, total cholesterol, albumin and prealbumin, hepatic encephalopathy, kidney damage, alpha-fetoprotein and vitamin D binding protein, blood sodium level, virus HBeAg expression and genotype, and blood glucose. 2. In addition to TBil, INR, hepatic encephalopathy, Cr level and AFP as indicators for prognosis of severe hepatitis, some other parameters such as clinical signs, symptoms, serum levels of total cholesterol and albumin and natrium, and coagulation factors are all valuable in assessment. The roles of cell apoptosis, liver regeneration and immunological parameters in assessing patient prognosis are under study. Prognostic evaluating systems include MELD score, MELD-Na score, iMELD score, KCI and CTP score. 3. Prevention of severe hepatitis B should be started in asymptomatic patients. Close observation, sufficient rest, adequate nutrition, meticulous nursing and psychological care, preventing and removing exacerbating factors, treating concomitant diseases, reasonable antiviral and comprehensive therapies are helpful to prevent CHB patients from developing to severe hepatitis. For patients who already have severe hepatitis B, the prevention and management of complications is important for lowering mortality rate. 4. New research directions in acute-on-chronic liver failure include: (1) Additional well controlled studies using present or new liver systems are warranted. Other approaches include the use of granulocyte colony stimulating factor to treat infections as well as the potential of use of stem cells to restore immune integrity and enhance liver regeneration. (2) Using new cell lines and animal models to understand the molecular biology of HBV, the immune response and to develop novel therapies. (3) Development of new anti-HBV strategies, e.g. silencing or remove cccDNA, enhancing immunologic clearance of HBV infection, inhibiting virus entry or HBc expression and using CRISP to disrupt cccDNA.

1 citations


Cites background from "Ability of King's College Criteria ..."

  • ...Despite these limitations, the sensitivity of CTP scoring predicting mortality was about 78%, and specificity was 83% [14]....

    [...]

Journal ArticleDOI
TL;DR: In this article , the authors proposed an Artificial Extracorporeal Liver Support System (ALS) for acute-on-chronic liver failure using Bilirubin-lactate-etiology score complementary and alternative medicine.
Abstract: Acute-on-chronic liver failure Artificial extracorporeal liver support system Acute fatty liver of pregnancy Autoimmune hepatitis Autoimmune hepatitis related acute liver failure Acute kidney injury Acute liver failure Acute liver failure caused by hepatitis A score Acute liver failure early dynamic score Acute liver failure-organ failure score Acute liver failure study group Acute physiology and chronic health evaluation Acetaminophen Acetaminophen related acute liver failure Acute severe autoimmune hepatitis Budd Chiari syndrome Budd chiari syndrome related acute-on-chronic liver failure Budd chiari syndrome related acute liver failure Bioartificial extracorporeal liver support system Bilirubin-lactate-etiology score complementary and alternative medicine Cold ischemia time Cytomegalovirus Continuous renal replacement therapy Dead donor liver transplantation Drug induced liver injury European Association for the Study of the Liver Extracorporeal liver support system Extracorporeal liver assist device Hepatitis A virus Hepatitis A virus related acute liver failure Hepatitis B virus Hepatitis B virus related acute liver failure Hepatic encephalopathy Hemolysis, elevated liver enzymes, low platelets Hepatitis E virus Human leukocyte antigen Herpes simplex virus High volume plasma exchange International normalized ratio King’s College criteria Living donor liver transplantation Liver transplantation Molecular adsorbent recirculating system 3,4- methylenedioxymethamphetamine Model for end stage liver disease; Model for end stage liver disease-sodium Multi organ dysfunction N acetyl cysteine N-acetylparabenzoquinone imine National Institutes of Health Negative predictive value Orthotopic liver transplantation Positive predictive value Spontaneous bacterial peritonitis Ribonucleic acid Specialized liver unit Single pass albumin dialysis Transplant free survival United Network for Organ Sharing Varicella zoster virus Wilson’s disease Wilson’s disease related acute liver failure None.

1 citations

Journal ArticleDOI
TL;DR: In this paper , a review of the surgical and critical care management of liver trauma is presented, including non-operative, operative, and radiologic strategies for traumatic liver injury including nonoperative,operative, radiologic.
Abstract: To review the surgical and critical care management of liver trauma; one of the most common abdominal injuries sustained due to its size and location.Hepatic injuries range from negligible to life threatening: in the acute phase, the most common cause of morbidity and mortality is hemorrhage; however, severe traumatic hepatic injuries can also lead to biochemical abnormalities, altered coagulation, and ultimately liver failure. This brief review will review the classification of traumatic liver injuries by mechanism, grade, and severity. Most Grades I-III injuries can be managed nonoperatively, whereas the majority of Grades IV-VI injuries require operative management. Therapeutic strategies for traumatic liver injury including nonoperative, operative, radiologic will be described. The primary goal of liver trauma management in the acute setting is hemorrhage control, then the management of secondary factors such as bile leaks. The rapid restoration of homeostasis may prevent further damage to the liver and allow for deferred nonoperative management, which has been shown to be associated with good clinical outcomes.A multidisciplinary approach to the care of these patients at an experienced liver surgery center is warranted.

1 citations

Journal ArticleDOI
TL;DR: In this paper , the authors evaluated the effectiveness of high-volume therapeutic plasma exchange (HV-TPE) in pediatric patients with acute liver failure and acute-on-chronic liver failure (ACLF).
Abstract: Purpose Liver transplantation (LT) is the only curative treatment for acute liver failure (ALF) and acute-on-chronic liver failure (ACLF). In high-volume therapeutic plasma exchange (HV-TPE), extracorporeal liver support filters accumulate toxins and improve the coagulation factor by replacing them. In this study, we aimed to evaluate the effectiveness of HV-TPE in pediatric patients with ALF and ACLF. Methods We reviewed the records of children waiting for LT at Severance Hospital who underwent HV-TPE between 2017 and 2021. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), total and direct bilirubin (TB and DB), gamma-glutamyl transferase (GGT), ammonia, and coagulation parameter-international normalized ratio (INR) were all measured before and after HV-TPE to analyze the liver function. The statistical analysis was performed using IBM SPSS Statistics for Windows, version 26.0 (IBM Co., Armonk, NY, USA). Results Nine patients underwent HV-TPE with standard medical therapy while waiting for LT. One had neonatal hemochromatosis, four had biliary atresia, and the other four had ALF of unknown etiology. Significant decreases in AST, ALT, TB, DB, GGT, and INR were noted after performing HV-TPE (930.38–331.75 IU/L, 282.62–63.00 IU/L, 11.75–5.59 mg/dL, 8.10–3.66 mg/dL, 205.62–51.75 IU/L, and 3.57–1.50, respectively, p<0.05). All patients underwent LT, and two expired due to acute complications. Conclusion HV-TPE could remove accumulated toxins and improve coagulation. Therefore, we conclude that HV-TPE can be regarded as a representative bridging therapy before LT.

1 citations

References
More filters
Journal ArticleDOI
04 Sep 2003-BMJ
TL;DR: A new quantity is developed, I 2, which the authors believe gives a better measure of the consistency between trials in a meta-analysis, which is susceptible to the number of trials included in the meta- analysis.
Abstract: Cochrane Reviews have recently started including the quantity I 2 to help readers assess the consistency of the results of studies in meta-analyses. What does this new quantity mean, and why is assessment of heterogeneity so important to clinical practice? Systematic reviews and meta-analyses can provide convincing and reliable evidence relevant to many aspects of medicine and health care.1 Their value is especially clear when the results of the studies they include show clinically important effects of similar magnitude. However, the conclusions are less clear when the included studies have differing results. In an attempt to establish whether studies are consistent, reports of meta-analyses commonly present a statistical test of heterogeneity. The test seeks to determine whether there are genuine differences underlying the results of the studies (heterogeneity), or whether the variation in findings is compatible with chance alone (homogeneity). However, the test is susceptible to the number of trials included in the meta-analysis. We have developed a new quantity, I 2, which we believe gives a better measure of the consistency between trials in a meta-analysis. Assessment of the consistency of effects across studies is an essential part of meta-analysis. Unless we know how consistent the results of studies are, we cannot determine the generalisability of the findings of the meta-analysis. Indeed, several hierarchical systems for grading evidence state that the results of studies must be consistent or homogeneous to obtain the highest grading.2–4 Tests for heterogeneity are commonly used to decide on methods for combining studies and for concluding consistency or inconsistency of findings.5 6 But what does the test achieve in practice, and how should the resulting P values be interpreted? A test for heterogeneity examines the null hypothesis that all studies are evaluating the same effect. The usual test statistic …

45,105 citations

Journal ArticleDOI
TL;DR: The MELD scale is a reliable measure of mortality risk in patients with end‐stage liver disease and suitable for use as a disease severity index to determine organ allocation priorities in patient groups with a broader range of disease severity and etiology.

4,184 citations

Journal ArticleDOI
TL;DR: This Mayo TIPS model may predict early death following elective TIPS for either prevention of variceal rebleeding or for treatment of refractory ascites, superior to both the Child‐Pugh classification and the Child-Pugh score in predicting survival.

2,479 citations

Journal ArticleDOI
TL;DR: Data suggest that the MELD score is able to accurately predict 3-month mortality among patients with chronic liver disease on the liver waiting list and can be applied for allocation of donor livers.

2,225 citations

Journal ArticleDOI
TL;DR: The effective sample size funnel plot and associated regression test of asymmetry should be used to detect publication bias and other sample size related effects in meta-analyses of test accuracy.

2,191 citations

Related Papers (5)
Frequently Asked Questions (2)
Q1. What have the authors contributed in "Meta-analysis of king's college criteria and model for end stage liver disease to predict outcome in acute liver failure" ?

The authors assessed the accuracy of King 's College Criteria ( KCC ) versus the Model-forEnd-Stage-Liver-Disease ( MELD ) in ALF through meta-analysis of studies which report the accuracy of both tests. 

The authors hope these data help inform such decisions and future research. A worsening grade of HE can be detected at the bedside and incorporated into KCC without awaiting further biochemical analysis.