Gomez EV, Bertot LC, Oramas BG, Soler EA, Navarro RL, Elias JD, Jiménez OV, Vazquez MDRA. Application of a biochemical and clinical model to predict individual survival in patients with end-stage liver disease. World J Gastroenterol 2009; 15(22): 2768-2777 [PMID: 19522028 DOI: 10.3748/wjg.15.2768]
Corresponding Author of This Article
Eduardo Vilar Gomez, National Institute of Gastroenterology, 25th Avenue, 503, Vedado, Havana 10400, Cuba. vilar@infomed.sld.cu
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Brief Articles
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World J Gastroenterol. Jun 14, 2009; 15(22): 2768-2777 Published online Jun 14, 2009. doi: 10.3748/wjg.15.2768
Application of a biochemical and clinical model to predict individual survival in patients with end-stage liver disease
Eduardo Vilar Gomez, Luis Calzadilla Bertot, Bienvenido Gra Oramas, Enrique Arus Soler, Raimundo Llanio Navarro, Javier Diaz Elias, Oscar Villa Jiménez, Maria del Rosario Abreu Vazquez
Eduardo Vilar Gomez, Luis Calzadilla Bertot, Enrique Arus Soler, Department of Hepatology, National Institute of Gastroenterology, Havana 10400, Cuba
Bienvenido Gra Oramas, Department of Pathology, National Institute of Gastroenterology, Havana 10400, Cuba
Raimundo Llanio Navarro, Department of Gastroenterology, National Institute of Gastroenterology, Havana 10400, Cuba
Javier Diaz Elias, Deparment of Gastroenterology, The “Calixto Garcia” Hospital, Havana 10400, Cuba
Oscar Villa Jiménez, Department of Gastroenterology, National Institute of Gastroenterology, Havana 10400, Cuba
Maria del Rosario Abreu Vazquez, Department of Biostatistics, National Institute of Gastroenterology, Havana 10400, Cuba
Author contributions: Gomez EV and Bertot LC contributed equally to this work; They performed the study, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript and statistical analysis; Oramas BG, Soler EA, Elias JD, Jiménez OV performed the design, acquisition of data, and analysis and interpretation of data; Navarro RL performed critical revision of the manuscript; Abreu Vazquez MR performed the statistical analysis.
Correspondence to: Eduardo Vilar Gomez, National Institute of Gastroenterology, 25th Avenue, 503, Vedado, Havana 10400, Cuba. vilar@infomed.sld.cu
Telephone: +53-7-8325067
Fax: +53-7-8333253
Received: February 11, 2009 Revised: May 1, 2009 Accepted: May 8, 2009 Published online: June 14, 2009
Abstract
AIM: To investigate the capability of a biochemical and clinical model, BioCliM, in predicting the survival of cirrhotic patients.
METHODS: We prospectively evaluated the survival of 172 cirrhotic patients. The model was constructed using clinical (ascites, encephalopathy and variceal bleeding) and biochemical (serum creatinine and serum total bilirubin) variables that were selected from a Cox proportional hazards model. It was applied to estimate 12-, 52- and 104-wk survival. The model’s calibration using the Hosmer-Lemeshow statistic was computed at 104 wk in a validation dataset. Finally, the model’s validity was tested among an independent set of 85 patients who were stratified into 2 risk groups (low risk ≤ 8 and high risk > 8).
RESULTS: In the validation cohort, all measures of fit, discrimination and calibration were improved when the biochemical and clinical model was used. The proposed model had better predictive values (c-statistic: 0.90, 0.91, 0.91) than the Model for End-stage Liver Disease (MELD) and Child-Pugh (CP) scores for 12-, 52- and 104-wk mortality, respectively. In addition, the Hosmer-Lemeshow (H-L) statistic revealed that the biochemical and clinical model (H-L, 4.69) is better calibrated than MELD (H-L, 17.06) and CP (H-L, 14.23). There were no significant differences between the observed and expected survival curves in the stratified risk groups (low risk, P = 0.61; high risk, P = 0.77).
CONCLUSION: Our data suggest that the proposed model is able to accurately predict survival in cirrhotic patients.
