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Short-term Survival in Acutely Decompensated Cirrhotic Patients

Angels Escorsell, Ferran Torres, Vega Catalina M, Antoni Mas, José Rios and Mònica Guevara.

Aim: The present study was aimed at the early identification of the prognostic factors for 30-day mortality in acutely decompensated cirrhotic patients.

Methods: Logistic regression models were used to study the predictors of mortality. Variables significant on univariate testing were included for the multivariate analysis. ROC curves were constructed. The model used retrospective data from 228 patients; and was prospectively validated among 64 patients from the Hospital Clinic: internal validation and 90 patients from Hospital Gregorio Maranon: external validation.

Results: The model identified age at admission, serum concentrations of bilirubin, creatinine and sodium, and INR obtained 2 to 8 days after admission as predictors of death in this population. The resulting risk score was highly accurate: AUROC: 0.9150, 95%CI: 0.8509-0.9790 also in the internal and external validation series, but not better that the most widely used scores in hepatology: MELD: 0.8335, 95%CI: 0.7486-0.9184, MELD-Na: 0.8565, 95%CI: 0.7774-0.9356, iMELD: 0.8972, 95%CI: 0.8297-0.9648 and MESO Index: 0.8464, 95%CI: 0.7656-0.9272. The cutoff levels: LR+, LR- of the new score, MELD and MELD-Na that best predicted 30 days mortality were -0.09: 38.6, 0.51, 28: 16.7, 0.42 and 47: 12, 0.7, respectively.

Conclusions: MELD, as well as new, more complicated and scanty used scores, obtained 2 to 8 days after admission allows the early and easy identification of patients with an acute decompensation of cirrhosis at high-risk of death on short-term follow-up. These scores may represent a useful tool to select the population suitable for studies to evaluate the efficacy of new therapies and stratify patients in randomized trials.