Article Impact Level: HIGH Data Quality: STRONG Summary of eGastroenterology, 2(3). https://doi.org/10.1136/egastro-2024-100101 Dr. Xia Yu et al.
Points
- Researchers developed the CATCH-LIFE-MELD score to improve the predictive accuracy for acute-on-chronic liver failure (ACLF) outcomes, addressing the limitations of the traditional MELD score.
- A meta-analysis of 32 studies identified 13 risk factors, with age, neutrophil count, and hepatic encephalopathy (HE) grade validated in prospective cohorts of 751 ACLF patients.
- The CATCH-LIFE-MELD score incorporates age, HE grade, neutrophil count, and MELD score, achieving concordance indices of 0.791 for 28-day and 0.788 for 90-day outcomes.
- The score demonstrated superior accuracy across diverse patient subgroups, including those with hepatitis B, cirrhosis, or liver failure, and met both COSSH and EASL criteria.
- The CATCH-LIFE-MELD score offers improved calibration and discrimination over traditional scores, providing a valuable tool for predicting short-term prognosis in ACLF management.
Summary
In a study aimed at improving prognostication for acute-on-chronic liver failure (ACLF), researchers identified additional predictive factors to enhance the model for end-stage liver disease (MELD) score, which is widely used for assessing end-stage liver disease but has limited performance in ACLF. The study conducted a meta-analysis of 32 cohort studies, which included 13,939 patients, to determine critical predictors for 28-day and 90-day outcomes of ACLF. Thirteen risk factors were identified, and three of these—age, neutrophil count, and hepatic encephalopathy (HE) grade—were validated in two prospective cohorts of 751 ACLF patients.
The researchers developed a new prognostic score, the Chinese Acute-on-Chronic Liver Failure Consortium (CATCH-LIFE)-MELD score, by incorporating these validated risk factors into the MELD score. The formula for the new score is as follows: 0.028×age + 0.3×HE grade + 0.039×neutrophil count + 0.079×MELD score. The CATCH-LIFE-MELD score demonstrated superior performance in predicting ACLF outcomes, achieving concordance indices of 0.791 and 0.788 for 28-day and 90-day outcomes, respectively. Additionally, the model showed superior discrimination based on metrics such as net reclassification and integrated discrimination improvement and was more accurately calibrated than traditional scoring methods.
The CATCH-LIFE-MELD score was consistently more accurate across various patient subgroups, including those with hepatitis B virus infection, cirrhosis, or liver failure, and in populations following both the Chinese Group on the Study of Severe Hepatitis B (COSSH) and European Association for the Study of the Liver (EASL) criteria. The study concluded that this modified MELD score offers improved accuracy in predicting the short-term prognosis of ACLF compared to other traditional scores, providing a valuable tool for clinicians managing ACLF patients.
Link to the article: https://egastroenterology.bmj.com/content/2/3/e100101
References Yu, X., Zhou, R., Tan, W., Wang, X., Zheng, X., Huang, Y., Chen, J., Li, B., Liu, X., Li, Z., Meng, Z., Gao, Y., Qian, Z., Liu, F., Lu, X., Shang, J., Yan, H., Zheng, Y., Zhang, W., … Shi, Y. (2024). Evidence-based incorporation of key parameters into MELD score for acute-on-chronic liver failure. eGastroenterology, 2(3). https://doi.org/10.1136/egastro-2024-100101
