David Goldberg1,2, Alejandro Mantero2, David Kaplan3,4, Cindy Delgado1, Binu John1,5, Nadine Nuchovich1, Ezekiel Emanuel6, Peter P Reese7. 1. Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA. 2. Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA. 3. Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA. 4. Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA. 5. Bruce Carter VA Medical Center, Miami, Florida, USA. 6. Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA. 7. Renal-Electrolye and Hypertension Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Abstract
BACKGROUND AND AIMS: Cirrhosis is a major cause of death and is associated with extensive health care use. Patients with cirrhosis have complex treatment choices due to risks of morbidity and mortality. To optimally counsel and treat patients with cirrhosis requires tools to predict their longer-term liver-related survival. We sought to develop and validate a risk score to predict longer-term survival of patients with cirrhosis. APPROACH AND RESULTS: We conducted a retrospective cohort study of adults with cirrhosis with no major life-limiting comorbidities. Adults with cirrhosis within the Veterans Health Administration were used for model training and internal validation, and external validation used the OneFlorida Clinical Research Consortium. We used four model-building approaches including variables predictive of cirrhosis-related mortality, focused on discrimination at key time points (1, 3, 5, and 10 years). Among 30,263 patients with cirrhosis ≤75 years old without major life-limiting comorbidities and complete laboratory data during the baseline period, the boosted survival tree models had the highest discrimination, with 1-year, 3-year, 5-year, and 10-year survival rates of 0.77, 0.81, 0.84, and 0.88, respectively. The 1-year, 3-year, and 5-year discrimination was nearly identical in external validation. Secondary analyses with imputation of missing data and subgroups by etiology of liver disease had similar results to the primary model. CONCLUSIONS: We developed and validated (internally and externally) a risk score to predict longer-term survival of patients with cirrhosis. This score would transform management of patients with cirrhosis in terms of referral to specialty care and treatment decision-making for non-liver-related care.
BACKGROUND AND AIMS: Cirrhosis is a major cause of death and is associated with extensive health care use. Patients with cirrhosis have complex treatment choices due to risks of morbidity and mortality. To optimally counsel and treat patients with cirrhosis requires tools to predict their longer-term liver-related survival. We sought to develop and validate a risk score to predict longer-term survival of patients with cirrhosis. APPROACH AND RESULTS: We conducted a retrospective cohort study of adults with cirrhosis with no major life-limiting comorbidities. Adults with cirrhosis within the Veterans Health Administration were used for model training and internal validation, and external validation used the OneFlorida Clinical Research Consortium. We used four model-building approaches including variables predictive of cirrhosis-related mortality, focused on discrimination at key time points (1, 3, 5, and 10 years). Among 30,263 patients with cirrhosis ≤75 years old without major life-limiting comorbidities and complete laboratory data during the baseline period, the boosted survival tree models had the highest discrimination, with 1-year, 3-year, 5-year, and 10-year survival rates of 0.77, 0.81, 0.84, and 0.88, respectively. The 1-year, 3-year, and 5-year discrimination was nearly identical in external validation. Secondary analyses with imputation of missing data and subgroups by etiology of liver disease had similar results to the primary model. CONCLUSIONS: We developed and validated (internally and externally) a risk score to predict longer-term survival of patients with cirrhosis. This score would transform management of patients with cirrhosis in terms of referral to specialty care and treatment decision-making for non-liver-related care.
Authors: Andrew S Levey; Kai-Uwe Eckardt; Yusuke Tsukamoto; Adeera Levin; Josef Coresh; Jerome Rossert; Dick De Zeeuw; Thomas H Hostetter; Norbert Lameire; Garabed Eknoyan Journal: Kidney Int Date: 2005-06 Impact factor: 10.612
Authors: David S Goldberg; Benjamin French; Kimberly A Forde; Peter W Groeneveld; Therese Bittermann; Lisa Backus; Scott D Halpern; David E Kaplan Journal: JAMA Date: 2014-03-26 Impact factor: 56.272
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Authors: David Goldberg; Alejandro Mantero; Craig Newcomb; Cindy Delgado; Kimberly A Forde; David E Kaplan; Binu John; Nadine Nuchovich; Barbara Dominguez; Ezekiel Emanuel; Peter P Reese Journal: J Hepatol Date: 2021-01-13 Impact factor: 30.083