Development and validation of a dynamic survival prediction model for patients with acute-on-chronic liver failure

Background & Aims: Acute-on-chronic liver failure (ACLF) is usually associated with a precipitating event and results in the failure of other organ systems and high short-term mortality. Current prediction models fail to adequately estimate prognosis and need for liver transplantation (LT) i...

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Autores principales:	Ben F.J. Goudsmit, Andries E. Braat, Maarten E. Tushuizen, Minneke J. Coenraad, Serge Vogelaar, Ian P.J. Alwayn, Bart van Hoek, Hein Putter
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	acute-on-chronic liver failure liver transplantation survival prediction Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/6fbc298c55c84b159b3f29e5a8dede3f
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spelling	oai:doaj.org-article:6fbc298c55c84b159b3f29e5a8dede3f2021-11-20T05:11:58ZDevelopment and validation of a dynamic survival prediction model for patients with acute-on-chronic liver failure2589-555910.1016/j.jhepr.2021.100369https://doaj.org/article/6fbc298c55c84b159b3f29e5a8dede3f2021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2589555921001452https://doaj.org/toc/2589-5559Background & Aims: Acute-on-chronic liver failure (ACLF) is usually associated with a precipitating event and results in the failure of other organ systems and high short-term mortality. Current prediction models fail to adequately estimate prognosis and need for liver transplantation (LT) in ACLF. This study develops and validates a dynamic prediction model for patients with ACLF that uses both longitudinal and survival data. Methods: Adult patients on the UNOS waitlist for LT between 11.01.2016-31.12.2019 were included. Repeated model for end-stage liver disease-sodium (MELD-Na) measurements were jointly modelled with Cox survival analysis to develop the ACLF joint model (ACLF-JM). Model validation was carried out using separate testing data with area under curve (AUC) and prediction errors. An online ACLF-JM tool was created for clinical application. Results: In total, 30,533 patients were included. ACLF grade 1 to 3 was present in 16.4%, 10.4% and 6.2% of patients, respectively. The ACLF-JM predicted survival significantly (p <0.001) better than the MELD-Na score, both at baseline and during follow-up. For 28- and 90-day predictions, ACLF-JM AUCs ranged between 0.840-0.871 and 0.833-875, respectively. Compared to MELD-Na, AUCs and prediction errors were improved by 23.1%-62.0% and 5%-37.6% respectively. Also, the ACLF-JM could have prioritized patients with relatively low MELD-Na scores but with a 4-fold higher rate of waiting list mortality. Conclusions: The ACLF-JM dynamically predicts outcome based on current and past disease severity. Prediction performance is excellent over time, even in patients with ACLF-3. Therefore, the ACLF-JM could be used as a clinical tool in the evaluation of prognosis and treatment in patients with ACLF. Lay summary: Acute-on-chronic liver failure (ACLF) progresses rapidly and often leads to death. Liver transplantation is used as a treatment and the sickest patients are treated first. In this study, we develop a model that predicts survival in ACLF and we show that the newly developed model performs better than the currently used model for ranking patients on the liver transplant waiting list.Ben F.J. GoudsmitAndries E. BraatMaarten E. TushuizenMinneke J. CoenraadSerge VogelaarIan P.J. AlwaynBart van HoekHein PutterElsevierarticleacute-on-chronic liver failureliver transplantationsurvival predictionDiseases of the digestive system. GastroenterologyRC799-869ENJHEP Reports, Vol 3, Iss 6, Pp 100369- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	acute-on-chronic liver failure liver transplantation survival prediction Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	acute-on-chronic liver failure liver transplantation survival prediction Diseases of the digestive system. Gastroenterology RC799-869 Ben F.J. Goudsmit Andries E. Braat Maarten E. Tushuizen Minneke J. Coenraad Serge Vogelaar Ian P.J. Alwayn Bart van Hoek Hein Putter Development and validation of a dynamic survival prediction model for patients with acute-on-chronic liver failure
description	Background & Aims: Acute-on-chronic liver failure (ACLF) is usually associated with a precipitating event and results in the failure of other organ systems and high short-term mortality. Current prediction models fail to adequately estimate prognosis and need for liver transplantation (LT) in ACLF. This study develops and validates a dynamic prediction model for patients with ACLF that uses both longitudinal and survival data. Methods: Adult patients on the UNOS waitlist for LT between 11.01.2016-31.12.2019 were included. Repeated model for end-stage liver disease-sodium (MELD-Na) measurements were jointly modelled with Cox survival analysis to develop the ACLF joint model (ACLF-JM). Model validation was carried out using separate testing data with area under curve (AUC) and prediction errors. An online ACLF-JM tool was created for clinical application. Results: In total, 30,533 patients were included. ACLF grade 1 to 3 was present in 16.4%, 10.4% and 6.2% of patients, respectively. The ACLF-JM predicted survival significantly (p <0.001) better than the MELD-Na score, both at baseline and during follow-up. For 28- and 90-day predictions, ACLF-JM AUCs ranged between 0.840-0.871 and 0.833-875, respectively. Compared to MELD-Na, AUCs and prediction errors were improved by 23.1%-62.0% and 5%-37.6% respectively. Also, the ACLF-JM could have prioritized patients with relatively low MELD-Na scores but with a 4-fold higher rate of waiting list mortality. Conclusions: The ACLF-JM dynamically predicts outcome based on current and past disease severity. Prediction performance is excellent over time, even in patients with ACLF-3. Therefore, the ACLF-JM could be used as a clinical tool in the evaluation of prognosis and treatment in patients with ACLF. Lay summary: Acute-on-chronic liver failure (ACLF) progresses rapidly and often leads to death. Liver transplantation is used as a treatment and the sickest patients are treated first. In this study, we develop a model that predicts survival in ACLF and we show that the newly developed model performs better than the currently used model for ranking patients on the liver transplant waiting list.
format	article
author	Ben F.J. Goudsmit Andries E. Braat Maarten E. Tushuizen Minneke J. Coenraad Serge Vogelaar Ian P.J. Alwayn Bart van Hoek Hein Putter
author_facet	Ben F.J. Goudsmit Andries E. Braat Maarten E. Tushuizen Minneke J. Coenraad Serge Vogelaar Ian P.J. Alwayn Bart van Hoek Hein Putter
author_sort	Ben F.J. Goudsmit
title	Development and validation of a dynamic survival prediction model for patients with acute-on-chronic liver failure
title_short	Development and validation of a dynamic survival prediction model for patients with acute-on-chronic liver failure
title_full	Development and validation of a dynamic survival prediction model for patients with acute-on-chronic liver failure
title_fullStr	Development and validation of a dynamic survival prediction model for patients with acute-on-chronic liver failure
title_full_unstemmed	Development and validation of a dynamic survival prediction model for patients with acute-on-chronic liver failure
title_sort	development and validation of a dynamic survival prediction model for patients with acute-on-chronic liver failure
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/6fbc298c55c84b159b3f29e5a8dede3f
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Development and validation of a dynamic survival prediction model for patients with acute-on-chronic liver failure

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