Researchers have designed an algorithm to help physicians make decisions on whether they should treat a patient suffering from End-Stage Liver Disease (ESLD). If the patient is most likely to die, and recommending intensive care treatment won’t benefit them, the physician should not recommend the treatment.
The algorithm, presented today at The International Liver Congress in Barcelona, gives a more accurate prediction on who is likely to benefit from treatment compared to previous measures, said hepatologist Katrine Landvig, the lead study author and a PhD fellow at the University of Copenhagen. The formula was able to successfully predict death in 96 percent of ESLD patients and is based on a combination of scales used to assess the severity of diseases, including Child-Pugh Score, Model for ESLD, and the CLIF-SOFA score.
Acute-on-chronic liver failure is a relatively common syndrome that occurs in 31 percent of patients hospitalized for an acute complication of cirrhosis who also have organ failure and are at high risk of short-term death. Patients suffering from acute-on-chronic liver failure are usually younger and have more scarring in the liver due to alcohol (as opposed to the scarring caused by Hepatitis C in patients with decompensated cirrhosis).
In order to test the algorithm, researchers looked at the data of 354 hospitalized patients suffering from cirrhosis. The patients were hospitalized in Belgium, Austria, and Denmark. The algorithm separated the patients into two groups: a group likely to benefit and survive ICU and a group who were not likely to benefit or survive ICU.
"If the first duty of a physician is to do no harm, then we must continually review our decision-making tools and favor those that have the highest predictive value of treatment success," said EASL Vice-Secretary Tom Hemming Karlsen. “This study adds to our knowledge of existing, well-recognized scoring systems, and provides an interesting approach for review and wider discussion by the liver community.”
Sources: European Association for the Study of the Liver press release via EurekAlert!
, “Acute-on-chronic Liver Failure” via Medscape