Ability of King's College Criteria and Model for End-stage Liver Disease Scores to Predict Mortality of Patients with Acute Liver Failure: A Meta-Analysis.
Clin Gastroenterol Hepatol. 2015 Oct 20;
Authors: McPhail MJ, Farne H, Senvar N, Wendon JA, Bernal W
BACKGROUND & AIMS: Several prognostic factors are used to identify patients with acute liver failure (ALF) who require emergency liver transplantation. We performed a meta-analysis to determine the accuracy of King's College criteria (KCC) vs the model for end-stage liver disease (MELD) scores in predicting hospital mortality among patients with ALF.
METHODS: We performed a systematic search of the literature for articles published from 2006 through 2015 that compared the accuracy of the KCC vs MELD scores in predicting hospital mortality in patients with ALF. We identified 23 studies (comprising 2153 patients) and assessed the quality of data, and then performed a meta-analysis of pooled sensitivity and specificity values, diagnostic odds ratios (DORs), and summary receiver operating characteristic (ROC) curves. Subgroups analyzed included study quality, era, location (Europe vs non-Europe), and size; ALF etiology (acetaminophen-associated ALF [AALF] vs non-associated [NAALF]); and whether or not the study included patients who underwent liver transplantation and if the study center was also a transplant center.
RESULTS: The DOR for the KCC was 5.3 (95% confidence interval [CI], 3.7-7.6; 57% heterogeneity) and the DOR for MELD score was 7.0 (95% CI, 5.1-9.7; 48% heterogeneity), so the MELD score and KCC are comparable in overall accuracy. The summary area under the ROC curve values were 0.76 for the KCC and 0.78 for MELD scores. The KCC identified patients with AALF who died with 58% sensitivity (95% CI, 51%-65) and 89% specificity (95% CI, 85%-93), whereas MELD scores identified patients with AALF who died with 80% sensitivity (95% CI, 74%-86) and 53% specificity (95% CI, 47%-59%). The KCC predicted hospital mortality in patients with NAALF with 58% sensitivity (95% CI, 54%-63) and 74% specificity (95% CI, 69%-78%), whereas MELD scores predicted hospital mortality in patients with NAALF with 76% sensitivity (95% CI, 72%-80%) and 73% specificity (95% CI, 69%-78%). In patients with AALF, the KCC's DOR was 10.4 (95% CI, 4.9-22.1) and the MELD score's DOR was 6.6 (95% CI, 2.1-20.2). In patients with NAALF, the KCC's DOR was 4.16 (95% CI, 2.34-7.40) and the MELD score's DOR was 8.42 (95% CI, 5.98-11.88).
CONCLUSIONS: Based on a meta-analysis of studies, the KCC more accurately predicts hospital mortality among patients with AALF, whereas MELD scores more accurately predict mortality among patients with NAALF. However, there is significant heterogeneity among studies and neither system is optimal for all patients. Given the importance of specificity in decision making for listing for emergency liver transplantation, MELD scores should not replace the KCC in predicting hospital mortality of patients with AALF, but could have a role for NAALF.
PMID: 26499930 [PubMed - as supplied by publisher]