Portal vein thrombosis compromises the performance of MELD and MELD-Na scores in patients with cirrhosis
Renjie Ouyang
Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
Department of Hepatology, Chenzhou No.1 People's Hospital, Chenzhou, China
Search for more papers by this authorHai Li
Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Search for more papers by this authorWenting Tan
Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
Search for more papers by this authorXianbo Wang
Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
Search for more papers by this authorXin Zheng
Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Search for more papers by this authorYan Huang
Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, China
Search for more papers by this authorZhongji Meng
Department of Infectious Diseases, Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, China
Search for more papers by this authorYanhang Gao
Department of Hepatology, The First Hospital of Jilin University, Jilin, China
Search for more papers by this authorZhiping Qian
Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
Search for more papers by this authorFeng Liu
Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, China
Search for more papers by this authorXiaobo Lu
Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
Search for more papers by this authorYu Shi
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
Search for more papers by this authorJia Shang
Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou, China
Search for more papers by this authorJunping Liu
Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou, China
Search for more papers by this authorGuohong Deng
Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
Search for more papers by this authorYubao Zheng
Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Search for more papers by this authorHuadong Yan
Department of Infectious Diseases, Shulan Hospital Affiliated to Zhejiang, Shuren University, Shulan International Medical College, Hangzhou, China
Search for more papers by this authorXiuhua Jiang
Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
Search for more papers by this authorYan Zhang
Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Search for more papers by this authorLiang Qiao
Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Search for more papers by this authorYi Zhou
Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
Search for more papers by this authorYixin Hou
Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
Search for more papers by this authorYan Xiong
Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Search for more papers by this authorJun Chen
Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, China
Search for more papers by this authorSen Luo
Department of Infectious Diseases, Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, China
Search for more papers by this authorNa Gao
Department of Hepatology, The First Hospital of Jilin University, Jilin, China
Search for more papers by this authorLiujuan Ji
Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
Search for more papers by this authorJing Li
Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, China
Search for more papers by this authorRongjiong Zheng
Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
Search for more papers by this authorHaotang Ren
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
Search for more papers by this authorHaiyu Wang
Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
Search for more papers by this authorGuotao Zhong
Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
Search for more papers by this authorCorresponding Author
Beiling Li
Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
Correspondence
Jinjun Chen and Beiling Li, Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No 1838, Guangzhou Dadao Bei, 510515, Guangzhou, China.
Email: [email protected] and [email protected]
Search for more papers by this authorCorresponding Author
Jinjun Chen
Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
Hepatology Unit, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Guangzhou, China
Correspondence
Jinjun Chen and Beiling Li, Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No 1838, Guangzhou Dadao Bei, 510515, Guangzhou, China.
Email: [email protected] and [email protected]
Search for more papers by this authorRenjie Ouyang
Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
Department of Hepatology, Chenzhou No.1 People's Hospital, Chenzhou, China
Search for more papers by this authorHai Li
Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Search for more papers by this authorWenting Tan
Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
Search for more papers by this authorXianbo Wang
Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
Search for more papers by this authorXin Zheng
Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Search for more papers by this authorYan Huang
Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, China
Search for more papers by this authorZhongji Meng
Department of Infectious Diseases, Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, China
Search for more papers by this authorYanhang Gao
Department of Hepatology, The First Hospital of Jilin University, Jilin, China
Search for more papers by this authorZhiping Qian
Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
Search for more papers by this authorFeng Liu
Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, China
Search for more papers by this authorXiaobo Lu
Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
Search for more papers by this authorYu Shi
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
Search for more papers by this authorJia Shang
Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou, China
Search for more papers by this authorJunping Liu
Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou, China
Search for more papers by this authorGuohong Deng
Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
Search for more papers by this authorYubao Zheng
Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Search for more papers by this authorHuadong Yan
Department of Infectious Diseases, Shulan Hospital Affiliated to Zhejiang, Shuren University, Shulan International Medical College, Hangzhou, China
Search for more papers by this authorXiuhua Jiang
Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
Search for more papers by this authorYan Zhang
Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Search for more papers by this authorLiang Qiao
Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Search for more papers by this authorYi Zhou
Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
Search for more papers by this authorYixin Hou
Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
Search for more papers by this authorYan Xiong
Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Search for more papers by this authorJun Chen
Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, China
Search for more papers by this authorSen Luo
Department of Infectious Diseases, Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, China
Search for more papers by this authorNa Gao
Department of Hepatology, The First Hospital of Jilin University, Jilin, China
Search for more papers by this authorLiujuan Ji
Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
Search for more papers by this authorJing Li
Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, China
Search for more papers by this authorRongjiong Zheng
Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
Search for more papers by this authorHaotang Ren
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
Search for more papers by this authorHaiyu Wang
Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
Search for more papers by this authorGuotao Zhong
Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
Search for more papers by this authorCorresponding Author
Beiling Li
Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
Correspondence
Jinjun Chen and Beiling Li, Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No 1838, Guangzhou Dadao Bei, 510515, Guangzhou, China.
Email: [email protected] and [email protected]
Search for more papers by this authorCorresponding Author
Jinjun Chen
Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
Hepatology Unit, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Guangzhou, China
Correspondence
Jinjun Chen and Beiling Li, Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No 1838, Guangzhou Dadao Bei, 510515, Guangzhou, China.
Email: [email protected] and [email protected]
Search for more papers by this authorRenjie Ouyang, Hai Li, Wenting Tan, Xianbo Wang, Xin Zheng, and Yan Huang contributed equally to this work.
Clinical trial number: NCT02457637, NCT03641872.
Abstract
Background and Aims
The accuracy of model for end-stage liver disease (MELD) and MELD with sodium (MELD-Na) scores in reflecting the clinical outcomes of patients with cirrhosis and portal vein thrombosis (PVT) remains unclear. This study aimed to evaluate the performance of scores in predicting 90-day mortality in patients with cirrhosis and PVT.
Methods
Post hoc analysis was performed in two prospective cohorts (NCT02457637 and NCT03641872). The correlation between the MELD/MELD-Na score and 90-day liver transplantation (LT)-free mortality was investigated in patients with cirrhosis with and without PVT.
Results
In this study, 2826 patients with cirrhosis were included, and 255 (9.02%) had PVT. The cumulative incidence of 90-day LT-free mortality did not significantly differ between patients with and without PVT (log-rank P = 0.0854). MELD [area under the receiver operating curve (AUROC), 0.649 vs. 0.842; P = 0.0036] and MELD-Na scores (AUROC, 0.691 vs. 0.851; P = 0.0108) were compared in patients with and without PVT, regarding the prediction of 90-day LT-free mortality. In MELD < 15 and MELD-Na < 20 subgroups, patients with PVT had a higher 90-day LT-free mortality than those without PVT (7.91% vs. 2.64%, log-rank P = 0.0011; 7.14% vs. 3.43%, log-rank P = 0.0223), whereas in MELD ≥ 15 and MELD-Na ≥ 20 subgroups, no significant difference was observed between patients with and without PVT.
Conclusions
The performance of MELD and MELD-Na scores in predicting 90-day LT-free mortality of patients with cirrhosis was compromised by PVT. MELD < 15 or MELD-Na < 20 may underestimate the 90-day LT-free mortality in patients with PVT.
Supporting Information
| Filename | Description |
|---|---|
| jgh16053-sup-0001-Supplemental information.docxWord 2007 document , 690 KB |
Figure S1. Kaplan–Meier graph of 90-day LT-free survival rates for patients with and without PVT. Abbreviations: LT, liver transplantation; PVT, portal vein thrombosis. Figure S2. Kaplan–Meier graph of 90-day LT-free survival rates: (A) Patients with HBV and those without, (B) Patients with alcohol-consuming and those without. Abbreviations: LT, liver transplantation. Figure S3. Receiver operating characteristic curves of MELD scores in predicting 90-day LT-free mortality in patients with and without PVT: (A) HBV-related patients, (B) Alcohol-consuming patients. Abbreviations: MELD, model for end-stage liver disease; LT, liver transplantation; PVT, portal vein thrombosis; AUROC, area under the receiver operating curve. Figure S4. Receiver operating characteristic curves of MELD-Na scores in predicting 90-day LT-free mortality in patients with and without PVT: (A) HBV-related patients, (B) Alcohol-consuming patients. Abbreviations: MELD-Na, model for end-stage liver disease-sodium; LT, liver transplantation; PVT, portal vein thrombosis; AUROC, area under the receiver operating curve. Figure S5. Association of MELD-Na scores in patients with and without PVT. (A): Absolute distribution of patients, (B): Relative distribution of patients, (C): Incidence of 90-day LT-free mortality for patients stratified by their MELD-Na scores. Abbreviations: LT, liver transplantation; PVT, portal vein thrombosis; MELD-Na, model for end-stage liver disease-sodium. Figure S6. Kaplan–Meier graph of 90-day LT-free survival rates of HBV-related patients with and without PVT: (A) Patients with MELD score <15, (B) Patients with MELD-Na score <20. Abbreviations: MELD, model for end-stage liver disease; MELD-Na, model for end-stage liver disease-sodium; LT, liver transplantation; PVT, portal vein thrombosis. Figure S7. Kaplan–Meier graph of 90-day LT-free survival rates of alcohol-consuming patients with and without PVT: (A) Patients with MELD score <15, (B) Patients with MELD-Na score <20. Abbreviations: MELD, model for end-stage liver disease; MELD-Na, model for end-stage liver disease-sodium; LT, liver transplantation; PVT, portal vein thrombosis. Table S1. The extent of PVT. Table S2. Univariate and multivariate analysis of risk factors for 90-day LT-free mortality in patients without PVT. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
References
- 1Qi X, Han G, Fan D. Management of portal vein thrombosis in liver cirrhosis. Nat. Rev. Gastroenterol. Hepatol. 2014; 11: 435–446.
- 2Intagliata NM, Caldwell SH, Tripodi A. Diagnosis, development, and treatment of portal vein thrombosis in patients with and without cirrhosis. Gastroenterology 2019; 156: 1582–1599.
- 3Senzolo M, Garcia-Tsao G, García-Pagán JC. Current knowledge and management of portal vein thrombosis in cirrhosis. J. Hepatol. 2021; 75: 442–453.
- 4Hernaez R, Liu Y, Kramer JR, Rana A, El-Serag HB, Kanwal F. Model for end-stage liver disease-sodium underestimates 90-day mortality risk in patients with acute-on-chronic liver failure. J. Hepatol. 2020; 73: 1425–1433.
- 5Starlinger P, Ahn JC, Mullan A et al. The addition of C-reactive protein and von Willebrand factor to MELD-Na improves prediction of waitlist mortality. Hepatology 2021; 74: 1533–1545.
- 6Bernardi M, Gitto S, Biselli M. The MELD score in patients awaiting liver transplant: Strengths and weaknesses. J. Hepatol. 2011; 54: 1297–1306.
- 7Martin P, Dimartini A, Feng S, Brown RJ, Fallon M. Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Hepatology 2014; 59: 1144–1165.
- 8Györi GP, Pereyra D, Rumpf B et al. The von Willebrand factor facilitates model for end-stage liver disease–independent risk stratification on the waiting list for liver transplantation. Hepatology 2020; 72: 584–594.
- 9Atiemo K, Skaro A, Maddur H et al. Mortality risk factors among patients with cirrhosis and a low model for end-stage liver disease sodium score (≤15): An analysis of liver transplant allocation policy using aggregated electronic health record data. Am. J. Transplant. 2017; 17: 2410–2419.
- 10van Vugt JLA, Alferink LJM, Buettner S et al. A model including sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant candidates: A competing risk analysis in a national cohort. J. Hepatol. 2018; 68: 707–714.
- 11Yoo HY, Edwin D, Thuluvath PJ. Relationship of the model for end-stage liver disease (MELD) scale to hepatic encephalopathy, as defined by electroencephalography and neuropsychometric testing, and ascites. Am. J. Gastroenterol. 2003; 98: 1395–1399.
- 12Huo T, Lin H, Lee F et al. Occurrence of cirrhosis-related complications is a time-dependent prognostic predictor independent of baseline model for end-stage liver disease score. Liver Int. 2006; 26: 55–61.
- 13Gu W, Xu B, Zheng X et al. Acute-on-chronic liver failure in China: Rationale for developing a patient registry and baseline characteristics. Am. J. Epidemiol. 2018; 187: 1829–1839.
- 14Qiao L, Wang X, Deng G et al. Cohort profile: A multicentre prospective validation cohort of the Chinese acute-on-chronic liver failure (CATCH-LIFE) study. BMJ Open 2021; 11: e37793.
- 15Zhang Y, Xu B, Wang X et al. Prevalence and clinical significance of portal vein thrombosis in patients with cirrhosis and acute decompensation. Clin. Gastroenterol. H. 2020; 18: 2564–2572.
- 16Kamath P, Wiesner RH, Malinchoc M et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001; 33: 464–470.
- 17Kim WR, Biggins SW, Kremers WK et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. New Engl. J. Med. 2008; 359: 1018–1026.
- 18Kumar A, Sharma P, Arora A. Review article: Portal vein obstruction - epidemiology, pathogenesis, natural history, prognosis and treatment. Aliment Pharm. Ther. 2015; 41: 276–292.
- 19Bhangui P, Lim C, Levesque E et al. Novel classification of non-malignant portal vein thrombosis: A guide to surgical decision-making during liver transplantation. J. Hepatol. 2019; 71: 1038–1050.
- 20Englesbe MJ, Schaubel DE, Cai S, Guidinger MK, Merion RM. Portal vein thrombosis and liver transplant survival benefit. Liver Transpl. 2010; 16: 999–1005.
- 21Steggerda JA, Kim IK, Todo T, Malinoski D, Klein AS, Bloom MB. Liver transplant survival index for patients with model for end-stage liver disease score ≥ 35: Modeling risk and adjusting expectations in the Share 35 era. J. Am. Coll. Surg. 2019; 228: 437–450.
- 22Abdallah MA, Kuo Y, Asrani S et al. Validating a novel score based on interaction between ACLF grade and MELD score to predict waitlist mortality. J. Hepatol. 2021; 74: 1355–1361.
