Prognostic Abilities and Quality Assessment of Models for the Prediction of 90-Day Mortality in Liver Transplant Waiting List Patients

Ricardo Salinas Saldaña; Harald Schrem; Marc Barthold; Alexander Kaltenborn

doi:10.1371/journal.pone.0170499

Prognostic Abilities and Quality Assessment of Models for the Prediction of 90-Day Mortality in Liver Transplant Waiting List Patients

PLoS One. 2017 Jan 27;12(1):e0170499. doi: 10.1371/journal.pone.0170499. eCollection 2017.

Authors

Ricardo Salinas Saldaña¹, Harald Schrem^{1

2}, Marc Barthold¹, Alexander Kaltenborn^{1

3}

Affiliations

¹ Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany.
² Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.
³ Department of Trauma and Orthopedic Surgery, Federal Armed Forces Hospital Westerstede, Westerstede, Germany.

Abstract

Background: Model of end-stage liver disease (MELD)-score and diverse variants are widely used for prognosis on liver transplant waiting-lists.

Methods: 818 consecutive patients on the liver transplant waiting-list included to calculate the MELD, MESO Index, MELD-Na, UKELD, iMELD, refitMELD, refitMELD-Na, upMELD and PELD-scores. Prognostic abilities for 90-day mortality were investigated applying Receiver-operating-characteristic-curve analysis. Independent risk factors for 90-day mortality were identified with multivariable binary logistic regression modelling. Methodological quality of the underlying development studies was assessed with a systematic assessment tool.

Results: 74 patients (9%) died on the liver transplant waiting list within 90 days after listing. All but one scores, refitMELD-Na, had acceptable prognostic performance with areas under the ROC-curves (AUROCs)>0.700. The iMELD performed best (AUROC = 0.798). In pediatric cases, the PELD-score just failed to reach the acceptable threshold with an AUROC = 0.699. All scores reached a mean quality score of 72.3%. Highest quality scores could be achieved by the UKELD and PELD-scores. Studies specifically lack statistical validity and model evaluation.

Conclusions: Inferior quality assessment of prognostic models does not necessarily imply inferior prognostic abilities. The iMELD might be a more reliable tool representing urgency of transplantation than the MELD-score. PELD-score is assumedly not accurate enough to allow graft allocation decision in pediatric liver transplantation.

MeSH terms

Adolescent
Adult
Aged
Child
Child, Preschool
End Stage Liver Disease / mortality*
End Stage Liver Disease / pathology
End Stage Liver Disease / surgery
Female
Humans
Infant
Liver / pathology
Liver Cirrhosis / mortality
Liver Transplantation*
Male
Middle Aged
Models, Theoretical
Prognosis*
Severity of Illness Index
Waiting Lists

Grants and funding

This work was supported by a grant from the German Federal Ministry of Education and Research (reference number: 01EO1302). The funders had no role in study design, data collection and Analysis, decision to publish, or preparation of the manuscript.