January 21, 2014
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Scoring system accurately predicted mortality among cirrhosis patients

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Researchers focusing on nine specific comorbidities have developed a scoring system that can predict death or survival of cirrhosis patients with strong accuracy, a recent study reported.

“Comorbidity is prevalent and strongly affects the mortality of cirrhosis patients. It must therefore be described, quantified and controlled for in epidemiologic studies of cirrhosis patients,” the researchers wrote. “The CirCom [cirrhosis-specific comorbidity] score … is developed specifically for these tasks. It had higher [Harrell’s] C statistic and NRI [Net Reclassification Index] values than the Charlson Comorbidity Index [CCI] and is easier to use.”

The researchers analyzed data contained in national registries from 12,976 Danish patients diagnosed with cirrhosis from 1999 to 2008 and followed through 2010.

Researchers then used a Cox regression analysis model to evaluate 34 candidate comorbidities before finding nine with an adjusted mortality HR of 1.2 or greater. Chronic kidney disease (adjusted HR=2; 95% CI, 1.55-2.58) and metastatic cancer (aHR=1.99; 95% CI, 1.64-2.42) had the greatest adjusted HR and were given a severity weight of 3 under the model. The other comorbidities — nonmetastatic or hematologic cancer, heart failure, substance abuse other than alcoholism, epilepsy, peripheral arterial disease, acute myocardial infarction and chronic obstructive pulmonary disease — were given a severity weight of 1.

Among the patients analyzed, 24.2% had CirCom scores of more than 1, and mortality correlated with these scores. Patients’ CirCom scores also correlated with the CCI (Kendall’s t=0.57; P<.0001).

CirCom score also increased Harrell’s C statistic by 0.6% (95% CI, 0.3%−0.8%) in comparison with the CCI. NRI for the CirCom score was 5.2% (95% CI, 3.7%−6.9%), while NRI for the CCI was 3.6% (95% CI, 2.3%−5%).

The researchers reported similar results from validation cohorts.

Disclosure: The researchers report no relevant financial disclosures.