Direct Bilirubin Is More Valuable than Total Bilirubin for Predicting Prognosis in Patients with Liver Cirrhosis
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background/Aims: Most prognostic prediction models for patients with liver cirrhosis include serum total bilirubin (TB) level as a component. This study investigated prognostic performance of serum direct bilirubin (DB) and developed new DB level-based prediction models for cirrhosis. Methods: A total of 983 hospitalized patients with liver cirrhosis were included. DB-Model for End-Stage Liver Disease (MELD) score was calculated using MELD score formula, with serum DB level replacing TB level. Results: Mean age of study population was 56.1 years. Alcoholic liver disease was the most frequent underlying condition (471 patients, 47.9%). Within 6 months, 144 patients (14.6%) died or received liver transplantation due to severe liver dysfunction. The area under the receiver operating characteristic curve (AUROC) for prediction of 6-month mortality with DB level was significantly higher than that with TB level (p<0.001). The AUROC of DB-MELD score for prediction of 6-month mortality was significantly higher than that of MELD score (p<0.001). Patients were randomly divided into training (n=492) and validation (n=491) cohorts. A new prognostic prediction model, “Direct Bilirubin, INR, and Creatinine” (DiBIC) score, was developed based on the most significant predictors of 6-month mortality. In training set, AUROC of DiBIC score for prediction of 6-month mortality was 0.892, which was significantly higher than that of the MELD score (0.875, p=0.017), but not different from that of DB-MELD score (0.886, p=0.272). Similar results were observed in validation set. Conclusions: New prognostic models, DB-MELD and DiBIC scores, have good prognostic performance in liver cirrhosis patients, outperforming other currently available models.
Abstract
Background/Aims: Most prognostic prediction models for patients with liver cirrhosis include serum total bilirubin (TB) level as a component. This study investigated prognostic performance of serum direct bilirubin (DB) and developed new DB level-based prediction models for cirrhosis. Methods: A total of 983 hospitalized patients with liver cirrhosis were included. DB-Model for End-Stage Liver Disease (MELD) score was calculated using MELD score formula, with serum DB level replacing TB level. Results: Mean age of study population was 56.1 years. Alcoholic liver disease was the most frequent underlying condition (471 patients, 47.9%). Within 6 months, 144 patients (14.6%) died or received liver transplantation due to severe liver dysfunction. The area under the receiver operating characteristic curve (AUROC) for prediction of 6-month mortality with DB level was significantly higher than that with TB level (p<0.001). The AUROC of DB-MELD score for prediction of 6-month mortality was significantly higher than that of MELD score (p<0.001). Patients were randomly divided into training (n=492) and validation (n=491) cohorts. A new prognostic prediction model, “Direct Bilirubin, INR, and Creatinine” (DiBIC) score, was developed based on the most significant predictors of 6-month mortality. In training set, AUROC of DiBIC score for prediction of 6-month mortality was 0.892, which was significantly higher than that of the MELD score (0.875, p=0.017), but not different from that of DB-MELD score (0.886, p=0.272). Similar results were observed in validation set. Conclusions: New prognostic models, DB-MELD and DiBIC scores, have good prognostic performance in liver cirrhosis patients, outperforming other currently available models.
참고문헌 (28)
- Scaglione S, "The epidemiology of cirrhosis in the United States : a population-based study", J Clin Gastroenterol, 49, pp.690~696 (2015)
- Kim HJ, "Important predictor of mortality in patients with end-stage liver disease", Clin Mol Hepatol, 19, pp.105~115 (2013)
- Lee HA, "Risk factors for dropout from the liver transplant waiting list of hepatocellular carcinoma patients under locoregional treatment", Transplant Proc, 50, pp.3521~3526 (2018)
- The Korean Association for the Study of the Liver, "2017 KASL clinical practice guidelines management of hepatitis C: Treatment of chronic hepatitis C", Clinical and Molecular Hepatology, 24(3), pp.230~277 (2018), 대한간학회
- Dae Hoe Gu, "Clinical usefulness of psoas muscle thickness for the diagnosis of sarcopenia in patients with liver cirrhosis", Clinical and Molecular Hepatology, 24(3), pp.319~330 (2018), 대한간학회
- 이순규, "Cardiac diastolic dysfunction predicts poor prognosis in patients with decompensated liver cirrhosis", Clinical and Molecular Hepatology, 24(4), pp.409~416 (2018), 대한간학회
- D’Amico G, "Natural history and prognostic indicators of survival in cirrhosis : a systematic review of 118 studies", J Hepatol, 44, pp.217~231 (2006)
- Child CG, "Surgery and portal hypertension", Major Probl Clin Surg, 1, pp.1~85 (1964)
- Kamath PS, "A model to predict survival in patients with end-stage liver disease", Hepatology, 33, pp.464~470 (2001)
- Zieve L, "Jaundice in cirrhosis", JAMA, 191, pp.475~479 (1965)
- Ohkubo A, "Bilirubin metabolism in liver cirrhosis", Nihon Rinsho, 52, pp.138~144 (1994)
- Felsher BF, "Indirect reacting hyperbilirubinemia in cirrhosis : its relation to red cell survival", Am J Dig Dis, 13, pp.598~607 (1968)
- Aravinthan AD, "Hepatocyte senescence explains conjugated bilirubinaemia in chronic liver failure", J Hepatol, 63, pp.532~533 (2015)
- Trauner M, "Molecular pathogenesis of cholestasis", N Engl J Med, 339, pp.1217~1227 (1998)
- Vítek L, "Bilirubin chemistry and metabolism; harmful and protective aspects", Curr Pharm Des, 15, pp.2869~2883 (2009)
- Jung KS, "Risk assessment of hepatitis B virus-related hepatocellular carcinoma development using liver stiffness measurement(FibroScan)", Hepatology, 53, pp.885~894 (2011)
- Hanley JA, "A method of comparing the areas under receiver operating characteristic curves derived from the same cases", Radiology, 148, pp.839~843 (1983)
- López-Velázquez JA, "Bilirubin alone as a biomarker for short-term mortality in acute-on-chronic liver failure: an important prognostic indicator", Ann Hepatol, 13, pp.98~104 (2013)
- Leise MD, "A revised model for end-stage liver disease optimizes prediction of mortality among patients awaiting liver transplantation", Gastroenterology, 140, pp.1952~1960 (2011)
- Kim WR, "Hyponatremia and mortality among patients on the liver-transplant waiting list", N Engl J Med, 359, pp.1018~1026 (2008)
- Sharma P, "Reweighting the model for end-stage liver disease score components", Gastroenterology, 135, pp.1575~1581 (2008)
- Kim TH, "Assessment and prediction of acute kidney injury in patients with decompensated cirrhosis with serum cystatin C and urine N-acetyl-β-Dglucosaminidase", J Gastroenterol Hepatol, 34, pp.234~240 (2019)
- Yoo JJ, "Estimation of renal function in patients with liver cirrhosis : impact of muscle mass and sex", J Hepatol, 70, pp.847~854 (2019)
- Peng Y, "Child-Pugh versus MELD score for the assessment of prognosis in liver cirrhosis: a systematic review and meta-analysis of observational studies", Medicine (Baltimore), 95, pp.e2877~ (2016)
- Said A, "Model for end stage liver disease score predicts mortality across a broad spectrum of liver disease", J Hepatol, 40, pp.897~903 (2004)
- Dickson ER, "Prognosis in primary biliary cirrhosis : model for decision making", Hepatology, 10, pp.1~7 (1989)
- Testa R, "Trans-catheter arterial chemoembolisation for hepatocellular carcinoma in patients with viral cirrhosis : role of combined staging systems, Cancer Liver Italian Program(CLIP)and Model for End-stage Liver Disease(MELD), in predicting outcome after treatment", Aliment Pharmacol Ther, 17, pp.1563~1569 (2003)
- Huo TI, "The model for end-stage liver disease based cancer staging systems are better prognostic models for hepatocellular carcinoma : a prospective sequential survey", Am J Gastroenterol, 102, pp.1920~1930 (2007)