Liver dysfunction by model for end-stage liver disease score improves mortality prediction in injured patients with cirrhosis

Michael G. Corneille, Susannah Nicholson, Jacqueline Richa, Colin Son, Joel Michalek, Steven Wolf, Ronald Stewart

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

BACKGROUND: Cirrhosis is associated with poor outcomes in the trauma setting. We aimed to evaluate the utility of Model for End-Stage Liver Disease (MELD) in assessing additional mortality risk in trauma patients with cirrhosis. METHODS: Injured patients with liver dysfunction were identified by hospital and trauma registry query. Presence of cirrhosis was confirmed by laparotomy, biopsy, or imaging. MELD classification, Child-Turcotte-Pugh (CTP) classification, Injury Severity Score (ISS), and Trauma ISS (TRISS) were recorded, and the primary outcome variable was hospital mortality. We assessed the validity of the four scoring systems in prediction of mortality, individually and in combinations, by comparing the areas under receiver operating characteristic curves (AUC), which is the probability, for scores that increase with the risk of death that a randomly chosen deceased subject will score higher than a randomly chosen living subject. RESULTS: A total of 163 patients with confirmed cirrhosis were included. ISS (AUC = 0.849, p < 0.001) and TRISS (AUC = 0.826, p < 0.001) were the strongest predictors of mortality. MELD (AUC = 0.725) was not a significantly stronger predictor of mortality than CTP (AUC = 0.639; p = 0.38). ISS + MELD (AUC = 0.891) and ISS + CTP (AUC = 0.897) were stronger predictors than ISS alone (AUC = 0.849; p < 0.001) for both. The MELD score was more available from the records than the CTP score (91.4% vs. 75.5%). CONCLUSION: In trauma patients with cirrhosis, a score that evaluates the degree of liver dysfunction enhances the ability of ISS alone to predict mortality. The MELD score is more readily available than the CTP score for the prediction of mortality in trauma patients.

Original languageEnglish (US)
Pages (from-to)6-11
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume71
Issue number1
DOIs
StatePublished - Jul 1 2011
Externally publishedYes

Fingerprint

End Stage Liver Disease
Injury Severity Score
Area Under Curve
Liver Diseases
Fibrosis
Mortality
Wounds and Injuries
Child Mortality
Hospital Mortality
ROC Curve
Laparotomy
Registries
Biopsy

Keywords

  • Child's Classification
  • Child-Pugh
  • Child-Turcotte-Pugh
  • Cirrhosis
  • End-stage liver disease
  • ISS
  • Liver dysfunction
  • MELD
  • Model for End-Stage Liver Disease
  • Outcomes
  • Trauma
  • TRISS

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Liver dysfunction by model for end-stage liver disease score improves mortality prediction in injured patients with cirrhosis. / Corneille, Michael G.; Nicholson, Susannah; Richa, Jacqueline; Son, Colin; Michalek, Joel; Wolf, Steven; Stewart, Ronald.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 71, No. 1, 01.07.2011, p. 6-11.

Research output: Contribution to journalArticle

Corneille, Michael G. ; Nicholson, Susannah ; Richa, Jacqueline ; Son, Colin ; Michalek, Joel ; Wolf, Steven ; Stewart, Ronald. / Liver dysfunction by model for end-stage liver disease score improves mortality prediction in injured patients with cirrhosis. In: Journal of Trauma - Injury, Infection and Critical Care. 2011 ; Vol. 71, No. 1. pp. 6-11.
@article{3f1fe465111f4487948fc9a7e41a1ae7,
title = "Liver dysfunction by model for end-stage liver disease score improves mortality prediction in injured patients with cirrhosis",
abstract = "BACKGROUND: Cirrhosis is associated with poor outcomes in the trauma setting. We aimed to evaluate the utility of Model for End-Stage Liver Disease (MELD) in assessing additional mortality risk in trauma patients with cirrhosis. METHODS: Injured patients with liver dysfunction were identified by hospital and trauma registry query. Presence of cirrhosis was confirmed by laparotomy, biopsy, or imaging. MELD classification, Child-Turcotte-Pugh (CTP) classification, Injury Severity Score (ISS), and Trauma ISS (TRISS) were recorded, and the primary outcome variable was hospital mortality. We assessed the validity of the four scoring systems in prediction of mortality, individually and in combinations, by comparing the areas under receiver operating characteristic curves (AUC), which is the probability, for scores that increase with the risk of death that a randomly chosen deceased subject will score higher than a randomly chosen living subject. RESULTS: A total of 163 patients with confirmed cirrhosis were included. ISS (AUC = 0.849, p < 0.001) and TRISS (AUC = 0.826, p < 0.001) were the strongest predictors of mortality. MELD (AUC = 0.725) was not a significantly stronger predictor of mortality than CTP (AUC = 0.639; p = 0.38). ISS + MELD (AUC = 0.891) and ISS + CTP (AUC = 0.897) were stronger predictors than ISS alone (AUC = 0.849; p < 0.001) for both. The MELD score was more available from the records than the CTP score (91.4{\%} vs. 75.5{\%}). CONCLUSION: In trauma patients with cirrhosis, a score that evaluates the degree of liver dysfunction enhances the ability of ISS alone to predict mortality. The MELD score is more readily available than the CTP score for the prediction of mortality in trauma patients.",
keywords = "Child's Classification, Child-Pugh, Child-Turcotte-Pugh, Cirrhosis, End-stage liver disease, ISS, Liver dysfunction, MELD, Model for End-Stage Liver Disease, Outcomes, Trauma, TRISS",
author = "Corneille, {Michael G.} and Susannah Nicholson and Jacqueline Richa and Colin Son and Joel Michalek and Steven Wolf and Ronald Stewart",
year = "2011",
month = "7",
day = "1",
doi = "10.1097/TA.0b013e31822311c5",
language = "English (US)",
volume = "71",
pages = "6--11",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Liver dysfunction by model for end-stage liver disease score improves mortality prediction in injured patients with cirrhosis

AU - Corneille, Michael G.

AU - Nicholson, Susannah

AU - Richa, Jacqueline

AU - Son, Colin

AU - Michalek, Joel

AU - Wolf, Steven

AU - Stewart, Ronald

PY - 2011/7/1

Y1 - 2011/7/1

N2 - BACKGROUND: Cirrhosis is associated with poor outcomes in the trauma setting. We aimed to evaluate the utility of Model for End-Stage Liver Disease (MELD) in assessing additional mortality risk in trauma patients with cirrhosis. METHODS: Injured patients with liver dysfunction were identified by hospital and trauma registry query. Presence of cirrhosis was confirmed by laparotomy, biopsy, or imaging. MELD classification, Child-Turcotte-Pugh (CTP) classification, Injury Severity Score (ISS), and Trauma ISS (TRISS) were recorded, and the primary outcome variable was hospital mortality. We assessed the validity of the four scoring systems in prediction of mortality, individually and in combinations, by comparing the areas under receiver operating characteristic curves (AUC), which is the probability, for scores that increase with the risk of death that a randomly chosen deceased subject will score higher than a randomly chosen living subject. RESULTS: A total of 163 patients with confirmed cirrhosis were included. ISS (AUC = 0.849, p < 0.001) and TRISS (AUC = 0.826, p < 0.001) were the strongest predictors of mortality. MELD (AUC = 0.725) was not a significantly stronger predictor of mortality than CTP (AUC = 0.639; p = 0.38). ISS + MELD (AUC = 0.891) and ISS + CTP (AUC = 0.897) were stronger predictors than ISS alone (AUC = 0.849; p < 0.001) for both. The MELD score was more available from the records than the CTP score (91.4% vs. 75.5%). CONCLUSION: In trauma patients with cirrhosis, a score that evaluates the degree of liver dysfunction enhances the ability of ISS alone to predict mortality. The MELD score is more readily available than the CTP score for the prediction of mortality in trauma patients.

AB - BACKGROUND: Cirrhosis is associated with poor outcomes in the trauma setting. We aimed to evaluate the utility of Model for End-Stage Liver Disease (MELD) in assessing additional mortality risk in trauma patients with cirrhosis. METHODS: Injured patients with liver dysfunction were identified by hospital and trauma registry query. Presence of cirrhosis was confirmed by laparotomy, biopsy, or imaging. MELD classification, Child-Turcotte-Pugh (CTP) classification, Injury Severity Score (ISS), and Trauma ISS (TRISS) were recorded, and the primary outcome variable was hospital mortality. We assessed the validity of the four scoring systems in prediction of mortality, individually and in combinations, by comparing the areas under receiver operating characteristic curves (AUC), which is the probability, for scores that increase with the risk of death that a randomly chosen deceased subject will score higher than a randomly chosen living subject. RESULTS: A total of 163 patients with confirmed cirrhosis were included. ISS (AUC = 0.849, p < 0.001) and TRISS (AUC = 0.826, p < 0.001) were the strongest predictors of mortality. MELD (AUC = 0.725) was not a significantly stronger predictor of mortality than CTP (AUC = 0.639; p = 0.38). ISS + MELD (AUC = 0.891) and ISS + CTP (AUC = 0.897) were stronger predictors than ISS alone (AUC = 0.849; p < 0.001) for both. The MELD score was more available from the records than the CTP score (91.4% vs. 75.5%). CONCLUSION: In trauma patients with cirrhosis, a score that evaluates the degree of liver dysfunction enhances the ability of ISS alone to predict mortality. The MELD score is more readily available than the CTP score for the prediction of mortality in trauma patients.

KW - Child's Classification

KW - Child-Pugh

KW - Child-Turcotte-Pugh

KW - Cirrhosis

KW - End-stage liver disease

KW - ISS

KW - Liver dysfunction

KW - MELD

KW - Model for End-Stage Liver Disease

KW - Outcomes

KW - Trauma

KW - TRISS

UR - http://www.scopus.com/inward/record.url?scp=79960408941&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79960408941&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e31822311c5

DO - 10.1097/TA.0b013e31822311c5

M3 - Article

VL - 71

SP - 6

EP - 11

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 1

ER -