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A model including sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant candidates: A competing risk analysis in a national cohort.
J Hepatol. 2018 04; 68(4):707-714.JH

Abstract

BACKGROUND & AIMS

Frail patients with low model for end-stage liver disease (MELD) scores may be under-prioritised. Low skeletal muscle mass, namely sarcopenia, has been identified as a risk factor for waiting list mortality. A recent study proposed incorporating sarcopenia in the MELD score (MELD-Sarcopenia score). We aimed to investigate the association between sarcopenia and waiting list mortality, and to validate the MELD-Sarcopenia score (i.e. MELD + 10.35 * Sarcopenia).

METHODS

We identified consecutive patients with cirrhosis listed for liver transplantation in the Eurotransplant registry between 2007-2014 and measured skeletal muscle mass on computed tomography. A competing risk analysis was used to compare survival of patients with and without sarcopenia, and concordance (c) indices were calculated to assess performance of the MELD and MELD-Sarcopenia score. We created a nomogram of the best predictive model.

RESULTS

We included 585 patients with a median MELD score of 14 (interquartile range 9-19), of which 254 (43.4%) were identified as having sarcopenia. Median waiting list survival was shorter in patients with sarcopenia than those without (p <0.001). This effect was even more pronounced in patients with MELD ≤15. The discriminative performance of the MELD-Sarcopenia score (c-index 0.820) for three-month mortality was lower than MELD score alone (c-index 0.839). Apart from sarcopenia and MELD score, other predictive variables were occurrence of hepatic encephalopathy before listing and recipient age. A model including all these variables yielded a c-index of 0.851.

CONCLUSIONS

Sarcopenia was associated with waiting list mortality in liver transplant candidates with cirrhosis, particularly in patients with lower MELD scores. The MELD-Sarcopenia score was successfully validated in this cohort. However, incorporating sarcopenia in the MELD score had limited added value in predicting waiting list mortality.

LAY SUMMARY

In this study among patients with liver cirrhosis listed for liver transplantation, low skeletal muscle mass was associated with mortality on the waiting list, particularly in patients who were listed with low priority based on a low MELD score. However, adding these measurements to the currently used system for donor and organ allocation showed no added value.

Authors+Show Affiliations

Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands. Electronic address: j.l.a.vanvugt@erasmusmc.nl.Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.Department of Dietetics, Leiden University Medical Centre, Leiden, the Netherlands.Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands.Department of Radiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, the Netherlands.Department of Gastroenterology and Hepatology, University of Groningen University Medical Centre Groningen, Groningen, the Netherlands.Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29221886

Citation

van Vugt, Jeroen Laurens Ad, et al. "A Model Including Sarcopenia Surpasses the MELD Score in Predicting Waiting List Mortality in Cirrhotic Liver Transplant Candidates: a Competing Risk Analysis in a National Cohort." Journal of Hepatology, vol. 68, no. 4, 2018, pp. 707-714.
van Vugt JLA, Alferink LJM, Buettner S, et al. A model including sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant candidates: A competing risk analysis in a national cohort. J Hepatol. 2018;68(4):707-714.
van Vugt, J. L. A., Alferink, L. J. M., Buettner, S., Gaspersz, M. P., Bot, D., Darwish Murad, S., Feshtali, S., van Ooijen, P. M. A., Polak, W. G., Porte, R. J., van Hoek, B., van den Berg, A. P., Metselaar, H. J., & IJzermans, J. N. M. (2018). A model including sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant candidates: A competing risk analysis in a national cohort. Journal of Hepatology, 68(4), 707-714. https://doi.org/10.1016/j.jhep.2017.11.030
van Vugt JLA, et al. A Model Including Sarcopenia Surpasses the MELD Score in Predicting Waiting List Mortality in Cirrhotic Liver Transplant Candidates: a Competing Risk Analysis in a National Cohort. J Hepatol. 2018;68(4):707-714. PubMed PMID: 29221886.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A model including sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant candidates: A competing risk analysis in a national cohort. AU - van Vugt,Jeroen Laurens Ad, AU - Alferink,Louise Johanna Maria, AU - Buettner,Stefan, AU - Gaspersz,Marcia Patricia, AU - Bot,Daphne, AU - Darwish Murad,Sarwa, AU - Feshtali,Shirin, AU - van Ooijen,Peter Martinus Adranius, AU - Polak,Wojciech Grzegorz, AU - Porte,Robert Jack, AU - van Hoek,Bart, AU - van den Berg,Aad Pieter, AU - Metselaar,Herold J, AU - IJzermans,Jan Nicolaas Maria, Y1 - 2017/12/06/ PY - 2017/05/29/received PY - 2017/11/22/revised PY - 2017/11/27/accepted PY - 2017/12/10/pubmed PY - 2019/7/13/medline PY - 2017/12/10/entrez KW - Cirrhosis KW - Competing risk analysis KW - Liver transplantation KW - MELD score KW - MELD-Sarcopenia score KW - Mortality KW - Sarcopenia KW - Waiting list SP - 707 EP - 714 JF - Journal of hepatology JO - J. Hepatol. VL - 68 IS - 4 N2 - BACKGROUND & AIMS: Frail patients with low model for end-stage liver disease (MELD) scores may be under-prioritised. Low skeletal muscle mass, namely sarcopenia, has been identified as a risk factor for waiting list mortality. A recent study proposed incorporating sarcopenia in the MELD score (MELD-Sarcopenia score). We aimed to investigate the association between sarcopenia and waiting list mortality, and to validate the MELD-Sarcopenia score (i.e. MELD + 10.35 * Sarcopenia). METHODS: We identified consecutive patients with cirrhosis listed for liver transplantation in the Eurotransplant registry between 2007-2014 and measured skeletal muscle mass on computed tomography. A competing risk analysis was used to compare survival of patients with and without sarcopenia, and concordance (c) indices were calculated to assess performance of the MELD and MELD-Sarcopenia score. We created a nomogram of the best predictive model. RESULTS: We included 585 patients with a median MELD score of 14 (interquartile range 9-19), of which 254 (43.4%) were identified as having sarcopenia. Median waiting list survival was shorter in patients with sarcopenia than those without (p <0.001). This effect was even more pronounced in patients with MELD ≤15. The discriminative performance of the MELD-Sarcopenia score (c-index 0.820) for three-month mortality was lower than MELD score alone (c-index 0.839). Apart from sarcopenia and MELD score, other predictive variables were occurrence of hepatic encephalopathy before listing and recipient age. A model including all these variables yielded a c-index of 0.851. CONCLUSIONS: Sarcopenia was associated with waiting list mortality in liver transplant candidates with cirrhosis, particularly in patients with lower MELD scores. The MELD-Sarcopenia score was successfully validated in this cohort. However, incorporating sarcopenia in the MELD score had limited added value in predicting waiting list mortality. LAY SUMMARY: In this study among patients with liver cirrhosis listed for liver transplantation, low skeletal muscle mass was associated with mortality on the waiting list, particularly in patients who were listed with low priority based on a low MELD score. However, adding these measurements to the currently used system for donor and organ allocation showed no added value. SN - 1600-0641 UR - https://www.unboundmedicine.com/medline/citation/29221886/A_model_including_sarcopenia_surpasses_the_MELD_score_in_predicting_waiting_list_mortality_in_cirrhotic_liver_transplant_candidates:_A_competing_risk_analysis_in_a_national_cohort_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0168-8278(17)32474-1 DB - PRIME DP - Unbound Medicine ER -