scholarly journals Nomogram to Predict the Survival of Chinese Patients with Alcohol-Related Liver Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Fangfang Duan ◽  
Chen Liu ◽  
Yuwei Liu ◽  
Chunyan Chang ◽  
Hang Zhai ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Cancer ◽  
Validation Cohort ◽  
Chinese Patients ◽  
Concordance Index ◽  
Term Survival ◽  
Training Cohort ◽  
Public Health Burden ◽  
Related Liver Disease ◽  
End Stage

Objectives. Alcohol-related liver disease is an increasing public health burden in China, but there is a lack of models to predict its prognosis. This study established a nomogram for predicting the survival of Chinese patients with alcohol-related liver disease (ALD). Methods. Hospitalized alcohol-related liver disease patients were retrospectively enrolled from 2015 to 2018 and followed up for 24 months to evaluate survival profiles. A total of 379 patients were divided into a training cohort (n = 265) and validation cohort (n = 114). Cox proportional hazard survival analysis identified survival factors of the patients in the training cohort. A nomogram was built and internally validated. Results. The 3-month, 6-month, 12-month, and 24-month survival rates for the training cohort were 82.6%, 81.1%, 74.3%, and 64.5%, respectively. The Cox analysis showed relapse ( P = 0.001 ), cirrhosis ( P = 0.044 ), liver cancer ( P < 0.001 ), and a model for end-stage liver diseases score of ≥21 ( P = 0.041 ) as independent prognostic factors. A nomogram was built, which predicted the survival of patients in the training cohort with a concordance index of 0.749 and in the internal validation cohort with a concordance index of 0.756. Conclusion. The long-term survival of Chinese alcohol-related liver disease patients was poor with a 24-month survival rate of 64.5%. Relapse, cirrhosis, liver cancer, and a model for end-stage liver disease score of ≥21 were independent risk factors for those patients. A nomogram was developed and internally validated for predicting the probability of their survival at different time points.

Refining TNM-8 M1 categories with anatomic subgroups for previously untreated de novo metastatic nasopharyngeal carcinoma.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6046-6046
Author(s):  
Sik-Kwan Chan ◽  
Cheng Lin ◽  
Shao Hui Huang ◽  
Tin Ching Chau ◽  
Qiaojuan Guo ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Nasopharyngeal Carcinoma ◽  
Bone Metastases ◽  
Validation Cohort ◽  
De Novo ◽  
Multivariable Analysis ◽  
Term Survival ◽  
Training Cohort ◽  
Study Results ◽  
Multivariable Analyses

6046 Background: The eighth edition TNM (TNM-8) classified de novo metastatic (metastatic disease at presentation) nasopharyngeal carcinoma (NPC) as M1 without further subdivision. However, survival heterogeneity exists and long-term survival has been observed in a subset of this population. We hypothesize that certain metastatic characteristics could further segregate survival for de novo M1 NPC. Methods: Patients with previously untreated de novo M1 NPC prospectively treated in two academic institutions (The University of Hong Kong [n = 69] and Provincial Clinical College of Fujian Medical University [n = 114] between 2007 and 2016 were recruited and re-staged based on TNM-8 in this study. They were randomized in 2:1 ratio to generate a training cohort (n = 120) and validation cohort (n = 63) respectively. Univariable and multivariable analyses (MVA) were performed for the training cohort to identify the anatomic prognostic factors of overall survival (OS). We then performed recursive partitioning analysis (RPA) which incorporated the anatomic prognostic factors identified in multivariable analyses and derived a new set of RPA stage groups (Anatomic-RPA groups) which predicted OS in the training cohort. The significance of Anatomic-RPA groups in the training cohort was then validated in the validation cohort. UVA and MVA were performed again on the validation cohorts to identify significant OS prognosticators. Results: The training and the validation cohorts had a median follow-up of 27.2 months and 30.2 months, respectively, with the 3-year OS of 51.6% and 51.1%, respectively. Univariable analysis (UVA) and multivariable analysis (MVA) revealed that co-existing liver and bone metastases was the only factor prognostic of OS. Anatomic-RPA groups based on the anatomic prognostic factors identified in UVA and MVA yielded good segregation (M1a: no co-existing liver and bone metastases and M1b: co-existing both liver and bone metastases; median OS 39.5 and 23.7 months respectively; P =.004). RPA for the validation set also confirmed good segregation with co-existing liver and bone metastases (M1a: no co-existing liver and bone metastases and M1b: co-existing liver and bone metastases), with median OS 47.7 and 16.0 months, respectively; P =.008). It was also the only prognostic factor in UVA and MVA in the validation cohort. Conclusions: Our Anatomic-RPA M1 stage groups with anatomical factors provided better subgroup segregation for de novo M1 NPC. The study results provide a robust justification to refine M1 categories in future editions of TNM staging classification.

Liver Transplantation for the Gastroenterologist

2015 ◽  
Author(s):  
Andreea M. Catana ◽  
Michael P. Curry
Keyword(s):  
United States ◽  
Liver Transplantation ◽  
Liver Disease ◽  
Organ Procurement ◽  
The United States ◽  
Waiting Lists ◽  
Liver Graft ◽  
Term Survival ◽  
End Stage Liver Disease ◽  
End Stage

The first liver transplantation (LT) was performed in 1963, and currently more than 65,000 people in the United States are living with a transplanted liver. In 2012, the number of adults who registered on the LT waiting list decreased for the first time since 2002; 10,143 candidates were added compared with 10,359 in 2011. LT offers long-term survival for complications of end-stage liver disease and prolongs life in properly selected patients, but problems such as donor deficit, geographic disparities, and long waiting lists remain. This overview of LT for the gastroenterologist details the indications for LT and patient selection, evaluation, liver organ allocation, prioritization for transplantation, transplantation benefit by the Model for End-Stage Liver Disease (MELD), MELD limitations, sources of liver graft, strategies employed to decrease the donor deficit, complications, and outcomes. Figures include indications for LT in Europe and the United States, Organ Procurement and Transplantation Network regions in the United States, the number of transplants and size of active waiting lists, mortality by MELD, regional disparity, patient survival rates with and without hepatitis C virus, and unadjusted patient and graft survival. Tables list LT milestones, indications for LT, contraindications for LT, minimal listing criteria for LT, criteria for LT in acute liver failure, LT evaluation process, adult recipient listing status 1A, and early posttransplantation complications. This review contains 7 highly rendered figures, 8 tables, and 46 references. 

scholarly journals Validation of a new prognostic model to predict short and medium-term survival in patients with liver cirrhosis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Tomasz Dziodzio ◽  
Robert Öllinger ◽  
Wenzel Schöning ◽  
Antonia Rothkäppel ◽  
Radoslav Nikolov ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Risk Score ◽  
Meld Score ◽  
Medium Term ◽  
Term Survival ◽  
Risk Of Death ◽  
Class B ◽  
Pugh Class ◽  
End Stage

Abstract Background MELD score and MELD score derivates are used to objectify and grade the risk of liver-related death in patients with liver cirrhosis. We recently proposed a new predictive model that combines serum creatinine levels and maximum liver function capacity (LiMAx®), namely the CreLiMAx risk score. In this validation study we have aimed to reproduce its diagnostic accuracy in patients with end-stage liver disease. Methods Liver function of 113 patients with liver cirrhosis was prospectively investigated. Primary end-point of the study was liver-related death within 12 months of follow-up. Results Alcoholic liver disease was the main cause of liver disease (n = 51; 45%). Within 12 months of follow-up 11 patients (9.7%) underwent liver transplantation and 17 (15.1%) died (13 deaths were related to liver disease, two not). Measures of diagnostic accuracy were comparable for MELD, MELD-Na and the CreLiMAx risk score as to power in predicting short and medium-term mortality risk in the overall cohort: AUROCS for liver related risk of death were for MELD [6 months 0.89 (95% CI 0.80–0.98) p < 0.001; 12 months 0.89 (95% CI 0.81–0.96) p < 0.001]; MELD-Na [6 months 0.93 (95% CI 0.85–1.00) p < 0.001 and 12 months 0.89 (95% CI 0.80–0.98) p < 0.001]; CPS 6 months 0.91 (95% CI 0.85–0.97) p < 0.01 and 12 months 0.88 (95% CI 0.80–0.96) p < 0.001] and CreLiMAx score [6 months 0.80 (95% CI 0.67–0.96) p < 0.01 and 12 months 0.79 (95% CI 0.64–0.94) p = 0.001]. In a subgroup analysis of patients with Child-Pugh Class B cirrhosis, the CreLiMAx risk score remained the only parameter significantly differing in non-survivors and survivors. Furthermore, in these patients the proposed score had a good predictive performance. Conclusion The CreLiMAx risk score appears to be a competitive and valid tool for estimating not only short- but also medium-term survival of patients with end-stage liver disease. Particularly in patients with Child-Pugh Class B cirrhosis the new score showed a good ability to identify patients not at risk of death.

scholarly journals Use of Granulocyte Colony-Stimulating Factor Among Patients of Chronic Liver Disease in a Tertiary Hospital in Nepal: A Pilot Study

2019 ◽  
Vol 18 (2) ◽  
pp. 53-59
Author(s):  
Rahul Pathak ◽  
Sabin Thapaliya
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Chronic Liver ◽  
Granulocyte Colony Stimulating Factor ◽  
Colony Stimulating Factor ◽  
Term Survival ◽  
End Stage Liver Disease ◽  
Standard Medical Therapy ◽  
End Stage ◽  
Stimulating Factor

Introduction: Granulocyte colony stimulating factor improves short-term survival and clinical outcomes in alcoholic hepatitis, acute-on-chronic liver failure and decompensated chronic liver disease. Our study aimed to assess survival benefit and change in Child-Turcotte-Pugh and Model For End-Stage Liver Disease scores 30 days after Granulocyte colony stimulating factor therapy in chronic liver disease patients, irrespective of their mode of presentation. Methods: This was a prospective observational study conducted in a university teaching hospital, where 25 patients with chronic liver disease were given 300 micrograms of Granulocyte colony stimulating factor subcutaneously 12 hourly plus standard medical therapy. We assessed survival until day 30. Child-Turcotte- Pugh and Model For End-Stage Liver Disease scores at enrolment and 30 days after treatment were compared. Results: 21 of 25 patients treated with Granulocyte colony stimulating factor survived at day 30. Treatment with Granulocyte colony stimulating factor reduced Child-Turcotte-Pugh score from 10.33 ± 1.24 to 8.76 ± 1.79 (p< 0.001) at day 30 and Model For End-Stage Liver Disease score from 22.10 ± 4.67 to 16.38 ± 5.52 (p < 0.001) at day 30. Conclusions: Granulocyte colony stimulating factor improves clinical outcome, Child-Turcotte-Pugh and Model For End-Stage Liver Disease scores in patients admitted with chronic liver disease for any cause. Further studies are needed to explore whether lower doses (total six doses) of Granulocyte colony stimulating factor are as effective as higher doses (total 10 doses). 

F.N.35 IMMUNOLOGY IN LIVER TRANSPLANTATION FOR END-STAGE HCV-RELATED LIVER DISEASE: A PRELIMINARY STUDY ON T REGULATORY CELL KINETICS

2010 ◽  
Vol 42 ◽  
pp. S46
Author(s):  
S. Ferri ◽  
C. Lalanne ◽  
M.C. Morelli ◽  
M. Bassi ◽  
P. Muratori ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Cell Kinetics ◽  
T Regulatory Cell ◽  
Regulatory Cell ◽  
Preliminary Study ◽  
Related Liver Disease ◽  
End Stage

192 THE LB MODEL: A NEW PROGNOSTIC TOOL FOR PREDICTION OF SHORT TERM SURVIVAL IN PATIENTS WITH END STAGE LIVER DISEASE

2008 ◽  
Vol 48 ◽  
pp. S81
Author(s):  
D. Duller ◽  
J. Haas ◽  
V. Stadlbauer ◽  
D. Kniepeiss ◽  
S.T. Palma ◽  
...  
Keyword(s):  
Liver Disease ◽  
Short Term ◽  
Term Survival ◽  
Prognostic Tool ◽  
End Stage Liver Disease ◽  
End Stage ◽  
Short Term Survival

scholarly journals Adenocarcinoma with mixed subtypes in the early and advanced gastric cancer.

2021 ◽  
Author(s):  
Xixian Zhao ◽  
Yizhang Li ◽  
Zhenwei Yang ◽  
Hailin Zhang ◽  
Hongling Wang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Validation Cohort ◽  
Signet Ring Cell Carcinoma ◽  
Signet Ring Cell ◽  
Cancer Specific Survival ◽  
Term Survival ◽  
Training Cohort ◽  
Clinical Benefits ◽  
Similar Survival

Abstract Background Based on the WHO classification, adenocarcinoma with mixed subtypes (AM) is a histological classification. We aimed to compare the prognosis among AM, classic adenocarcinoma (CA), mucinous adenocarcinoma (MAC), and signet-ring cell carcinoma (SRCC) in early and advanced gastric cancer (EGC, AGC), respectively. Methods We compared the clinicopathologic features and prognosis between AM and other histologic subtypes of CA, SRCC and MAC in ECG and ACG, respectively. A nomogram was established to predict the cancer-specific survival (CSS) of gastric cancer (GC) patients with AM. C-index, calibration curves, Receiver Operating Characteristic (ROC) and Decision Curve Analysis (DCA) curves were applied to examine the accuracy and clinical benefits. Results In the prognosis among these four histological subtypes in EGC patients, there are no differences. For AGC patients, AM had a significantly poorer prognosis compared with CA and MAC (P = 0.003, 0.029), but similar prognosis to SRCC. A nomogram based on race, T stage, N stage, M stage and surgical modalities were proposed to predict 1- and 3- year CSS for GC patients with AM (C-index: training cohort: 0.804, validation cohort: 0.748. 1-, 3-year CSS AUC: training cohort: 0.871, 0.914, validation cohort: 0.810, 0.798). 1- and 3-year CSS DCA curves showed good net benefits. Conclusions EGC patients with AM had similar survival to those with CA, MAC and SRCC. AM was an independent predictor of poor prognosis in AGC. A nomogram for predicting the prognosis of GC patients with AM was proposed to quantitatively assess the long-term survival.

scholarly journals Development and validation of a nomogram for predicting nonalcoholic fatty liver disease in the non-obese Chinese population

2020 ◽  
Author(s):  
Jiao Wang ◽  
Yunliang Tang ◽  
Kaili Peng ◽  
Honghong Liu ◽  
Jixiong Xu
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Nonalcoholic Fatty Liver Disease ◽  
Predictive Modeling ◽  
Fatty Liver Disease ◽  
Chinese Population ◽  
Validation Cohort ◽  
Risk Groups ◽  
Training Cohort ◽  
Nonalcoholic Fatty Liver

Abstract Background Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, and can be found in non-obese individuals. The purpose of this study was to construct and validate a model for predicting NAFLD in the non-obese Chinese population. Methods A total of 13240 NAFLD-free individuals at baseline from a 4-y longitudinal study were allocated to a training cohort (n = 8872) and a validation cohort (n = 4368). Cox proportional hazards regression analyses were used to select significant variables, and a nomogram was developed to predict NAFLD incidence in the training cohort. Concordance index (C-index), receiver operating characteristic (ROC) curves and calibration curves were applied to assess the predictive modeling of the nomogram in training and validation cohorts. Individuals were categorized into high- or low-risk groups based on median risk scores from the nomogram. Then, a decision curve analysis (DCA) was used to estimate the clinical usefulness of the nomogram in the combined training and validation cohorts. Results The overall incidence of NAFLD was 13%. Nine significant predictors including age, gender, body mass index (BMI), fasting blood glucose (FBG), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-c), uric acid (UA) and alanine aminotransferase (ALT) were identified and constructed for the nomogram. The C-index was 0.804 [95% CI, 0.792–0.852] and 0.802 [95% CI, 0.784–0.820] in the training and validation cohorts, respectively. In the training cohort, the area under the ROC curve (AUC) for 1-y, 2-y, 3-y and 4-y risk was 0.835, 0.825, 0.816 and 0.782, respectively. Likewise, in the validation cohort, the AUC for 1-y, 2-y, 3-y and 4-y risk was 0.817, 0.820, 0.814 and 0.813. The calibration curves for NAFLD risk showed excellent accuracy in the predictive modeling of the nomogram, internally and externally. The nomogram categorized individuals into high- and low-risk groups, and the DCA displayed the clinical usefulness of the nomogram for predicting NAFLD incidence. Conclusions Our nomogram can predict a personalized risk of NAFLD in the non-obese Chinese population. This nomogram can serve as a simple and affordable tool for stratifying individuals at a high risk of NAFLD, and thus serve to expedite treatment of NAFLD.

Pre-Liver Transplantation Evaluation and Listing

2019 ◽  
Vol 03 (04) ◽  
pp. 255-262
Author(s):  
Alexander Pan ◽  
Sean Koppe
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Comprehensive Evaluation ◽  
Organ Distribution ◽  
Post Transplantation ◽  
Term Survival ◽  
Transplant Candidates ◽  
Liver Transplant Waiting List ◽  
End Stage ◽  
Survival Risk

AbstractLiver transplantation provides a curative treatment option for patients with both acute and chronic liver disease, but the decision to list a patient for transplant should be an informed one to maximize post-transplantation benefit and survivability. Potential candidates meeting transplantation indications must undergo a comprehensive evaluation consisting of both physical, as well as psychiatric, assessment to be considered for transplantation. Once listed, a candidate's place on the liver transplant waiting list is determined predominantly by his or her Model for End-Stage Liver Disease (MELD)-Na score, which is a reliable tool to stratify short-term survival risk. The severity of certain conditions, however, is not accurately reflected by the MELD-Na score, and these particular diagnoses may be assigned MELD exception points. Herein, we discuss common indications for liver transplantation: the MELD system and its exceptions, the physical and psychosocial evaluation of potential transplant candidates, and some limitations of the current organ allocation system and efforts to reduce disparity in organ distribution.

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