Extra-hepatic comorbidity burden significantly increases 90-day mortality in patients with cirrhosis and high model for
- PDF / 687,868 Bytes
- 11 Pages / 595.276 x 790.866 pts Page_size
- 34 Downloads / 169 Views
RESEARCH ARTICLE
Open Access
Extra-hepatic comorbidity burden significantly increases 90-day mortality in patients with cirrhosis and high model for endstage liver disease Scott Coppel1, Karan Mathur2, Burcin Ekser3, Kavish R. Patidar2, Eric Orman2, Archita P. Desai2, Eduardo Vilar-Gomez2, Chandrashekhar Kubal3, Naga Chalasani2, Lauren Nephew2† and Marwan Ghabril2*†
Abstract Background: We examined how extra-hepatic comorbidity burden impacts mortality in patients with cirrhosis referred for liver transplantation (LT). Methods: Adults with cirrhosis evaluated for their first LT in 2012 were followed through their clinical course with last follow up in 2019. Extra-hepatic comorbidity burden was measured using the Charlson Comorbidity Index (CCI). The endpoints were 90-day transplant free survival (Cox-Proportional Hazard regression), and overall mortality (competing risk analysis). Results: The study included 340 patients, mean age 56 ± 11, 63% male and MELD-Na 17.2 ± 6.6. The CCI was 0 (no comorbidities) in 44%, 1–2 in 44% and > 2 (highest decile) in 12%, with no differences based on gender but higher CCI in patients with fatty and cryptogenic liver disease. Thirty-three (10%) of 332 patients not receiving LT within 90 days died. Beyond MELD-Na, the CCI was independently associated with 90-day mortality (hazard ratio (HR), 1.32 (95% confidence interval (CI) 1.02–1.72). Ninety-day mortality was specifically increased with higher CCI category and MELD ≥18 (12% (CCI = 0), 22% (CCI = 1–2) and 33% (CCI > 2), (p = 0.002)) but not MELD-Na ≤17. At last followup, 69 patients were alive, 100 underwent LT and 171 died without LT. CCI was associated with increased overall mortality in the competing risk analysis (Sub-HR 1.24, 95%CI 1.1–1.4). Conclusions: Extra-hepatic comorbidity burden significantly impacts short-term mortality in patients with cirrhosis and high MELD-Na. This has implications in determining urgency of LT and mortality models in cirrhosis and LT waitlisting, especially with an ageing population with increasing prevalence of fatty liver disease. Keywords: Cirrhosis, Comorbidity, Charlson comorbidity index, Liver transplantation, Mortality
* Correspondence: [email protected] † Lauren Nephew and Marwan Ghabril share senior authorship 2 Gastroenterology and Hepatology, Indiana University, 702 Rotary Circle, suite 225, Indianapolis, IN 46202, USA Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creati
Data Loading...
