Potential value and limitations of different clinical scoring systems in the assessment of short- and long-term outcome following orthotopic liver transplantation
In an attempt to further improve liver allograft utilization and outcome in orthotopic liver transplantation (OLT), a variety of clinical scoring systems have been developed. Here we aimed to comparatively investigate the association of the Balance-of-Risk (BAR), Survival-Outcomes-Following-Liver-Tr...
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| creator | Boecker, Joerg Czigany, Zoltan Bednarsch, Jan Amygdalos, Iakovos Meister, Franziska Santana, Daniel Antonio Morales Liu, Wen-Jia Strnad, Pavel Neumann, Ulf Peter Lurje, Georg |
| description | In an attempt to further improve liver allograft utilization and outcome in orthotopic liver transplantation (OLT), a variety of clinical scoring systems have been developed. Here we aimed to comparatively investigate the association of the Balance-of-Risk (BAR), Survival-Outcomes-Following-Liver-Transplant (SOFT), Preallocation-Survival-Outcomes-Following-Liver-Transplant (pSOFT), Donor-Risk-Index (DRI), and the Eurotransplant-Donor-Risk-Index (ET-DRI) scores with short- and long-term outcome following OLT.
We included 338 consecutive patients, who underwent OLT in our institution between May 2010 and November 2017. For each prognostic model, the optimal cutoff values were determined with the help of the Youden-index and their diagnostic accuracy for 90-day post OLT-mortality and major postoperative complications was measured by the area under the receiver operating characteristic curve (AUROC). Patient- and graft survival were analyzed using the Kaplan-Meier method and the log-rank test. Morbidity was assessed using the Clavien-Dindo classification and the Comprehensive-Complication-Index.
BAR, SOFT, and pSOFT performed well above the conventional AUROC-threshold of 0.70 with good prediction of early mortality. Only BAR showed AUC>0.70 for both mortality and major morbidity. With the cutoffs of 14, 31, and 22 respectively for BAR, SOFT, and pSOFT, subgroup analysis showed significant differences (p |
| doi_str_mv | 10.1371/journal.pone.0214221 |
| format | Article |
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We included 338 consecutive patients, who underwent OLT in our institution between May 2010 and November 2017. For each prognostic model, the optimal cutoff values were determined with the help of the Youden-index and their diagnostic accuracy for 90-day post OLT-mortality and major postoperative complications was measured by the area under the receiver operating characteristic curve (AUROC). Patient- and graft survival were analyzed using the Kaplan-Meier method and the log-rank test. Morbidity was assessed using the Clavien-Dindo classification and the Comprehensive-Complication-Index.
BAR, SOFT, and pSOFT performed well above the conventional AUROC-threshold of 0.70 with good prediction of early mortality. Only BAR showed AUC>0.70 for both mortality and major morbidity. With the cutoffs of 14, 31, and 22 respectively for BAR, SOFT, and pSOFT, subgroup analysis showed significant differences (p<0.001) in morbidity and mortality, length of intensive care- and hospital-stay and early allograft dysfunction rates. Five-years patient survival was inferior in the high BAR, pSOFT, and SOFT groups.
Out of all scores tested, the BAR-score had the best value in predicting both 90-day morbidity and mortality after OLT showing the highest AUCs. The pSOFT and SOFT scores demonstrated an acceptable accuracy in predicting 90-day morbidity and mortality. The used BAR, SOFT, and pSOFT cutoffs allowed the identification of patients at risk in terms of five-year patient survival. The DRI and ET-DRI scores have failed to predict recipient outcomes in the present setting.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0214221</identifier><identifier>PMID: 30897167</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Allografts ; Analysis ; Blood products ; Complications ; Complications and side effects ; Diagnostic systems ; Female ; Graft Survival ; Health aspects ; Health risks ; Hospitals ; Humans ; Liver ; Liver diseases ; Liver transplantation ; Liver Transplantation - methods ; Liver Transplantation - mortality ; Liver transplants ; Male ; Medicine and Health Sciences ; Middle Aged ; Morbidity ; Mortality ; Organ transplantation ; Outcome and process assessment (Medical care) ; Patients ; Postoperative complications ; Predictions ; Prognosis ; Rank tests ; Risk ; Romania ; Subgroups ; Surgeons ; Surgery ; Surgical outcomes ; Survival ; Survival Analysis ; Tissue Donors ; Transplantation ; Transplants & implants ; Treatment Outcome</subject><ispartof>PloS one, 2019-03, Vol.14 (3), p.e0214221-e0214221</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Boecker et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Boecker et al 2019 Boecker et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c585t-8f5ba00c70e028980eb3d138bfed2fa234699e054e9dd33db063ef6e8d82f3ca3</citedby><cites>FETCH-LOGICAL-c585t-8f5ba00c70e028980eb3d138bfed2fa234699e054e9dd33db063ef6e8d82f3ca3</cites><orcidid>0000-0003-0373-3210 ; 0000-0001-9674-0756</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6428268/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6428268/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79569,79570</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30897167$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Boecker, Joerg</creatorcontrib><creatorcontrib>Czigany, Zoltan</creatorcontrib><creatorcontrib>Bednarsch, Jan</creatorcontrib><creatorcontrib>Amygdalos, Iakovos</creatorcontrib><creatorcontrib>Meister, Franziska</creatorcontrib><creatorcontrib>Santana, Daniel Antonio Morales</creatorcontrib><creatorcontrib>Liu, Wen-Jia</creatorcontrib><creatorcontrib>Strnad, Pavel</creatorcontrib><creatorcontrib>Neumann, Ulf Peter</creatorcontrib><creatorcontrib>Lurje, Georg</creatorcontrib><title>Potential value and limitations of different clinical scoring systems in the assessment of short- and long-term outcome following orthotopic liver transplantation</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>In an attempt to further improve liver allograft utilization and outcome in orthotopic liver transplantation (OLT), a variety of clinical scoring systems have been developed. Here we aimed to comparatively investigate the association of the Balance-of-Risk (BAR), Survival-Outcomes-Following-Liver-Transplant (SOFT), Preallocation-Survival-Outcomes-Following-Liver-Transplant (pSOFT), Donor-Risk-Index (DRI), and the Eurotransplant-Donor-Risk-Index (ET-DRI) scores with short- and long-term outcome following OLT.
We included 338 consecutive patients, who underwent OLT in our institution between May 2010 and November 2017. For each prognostic model, the optimal cutoff values were determined with the help of the Youden-index and their diagnostic accuracy for 90-day post OLT-mortality and major postoperative complications was measured by the area under the receiver operating characteristic curve (AUROC). Patient- and graft survival were analyzed using the Kaplan-Meier method and the log-rank test. Morbidity was assessed using the Clavien-Dindo classification and the Comprehensive-Complication-Index.
BAR, SOFT, and pSOFT performed well above the conventional AUROC-threshold of 0.70 with good prediction of early mortality. Only BAR showed AUC>0.70 for both mortality and major morbidity. With the cutoffs of 14, 31, and 22 respectively for BAR, SOFT, and pSOFT, subgroup analysis showed significant differences (p<0.001) in morbidity and mortality, length of intensive care- and hospital-stay and early allograft dysfunction rates. Five-years patient survival was inferior in the high BAR, pSOFT, and SOFT groups.
Out of all scores tested, the BAR-score had the best value in predicting both 90-day morbidity and mortality after OLT showing the highest AUCs. The pSOFT and SOFT scores demonstrated an acceptable accuracy in predicting 90-day morbidity and mortality. The used BAR, SOFT, and pSOFT cutoffs allowed the identification of patients at risk in terms of five-year patient survival. The DRI and ET-DRI scores have failed to predict recipient outcomes in the present setting.</description><subject>Aged</subject><subject>Allografts</subject><subject>Analysis</subject><subject>Blood products</subject><subject>Complications</subject><subject>Complications and side effects</subject><subject>Diagnostic systems</subject><subject>Female</subject><subject>Graft Survival</subject><subject>Health aspects</subject><subject>Health risks</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Liver</subject><subject>Liver diseases</subject><subject>Liver transplantation</subject><subject>Liver Transplantation - methods</subject><subject>Liver Transplantation - mortality</subject><subject>Liver transplants</subject><subject>Male</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Organ transplantation</subject><subject>Outcome and process assessment (Medical care)</subject><subject>Patients</subject><subject>Postoperative complications</subject><subject>Predictions</subject><subject>Prognosis</subject><subject>Rank tests</subject><subject>Risk</subject><subject>Romania</subject><subject>Subgroups</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Survival</subject><subject>Survival Analysis</subject><subject>Tissue Donors</subject><subject>Transplantation</subject><subject>Transplants & implants</subject><subject>Treatment 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value and limitations of different clinical scoring systems in the assessment of short- and long-term outcome following orthotopic liver transplantation</title><author>Boecker, Joerg ; Czigany, Zoltan ; Bednarsch, Jan ; Amygdalos, Iakovos ; Meister, Franziska ; Santana, Daniel Antonio Morales ; Liu, Wen-Jia ; Strnad, Pavel ; Neumann, Ulf Peter ; Lurje, Georg</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c585t-8f5ba00c70e028980eb3d138bfed2fa234699e054e9dd33db063ef6e8d82f3ca3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Allografts</topic><topic>Analysis</topic><topic>Blood products</topic><topic>Complications</topic><topic>Complications and side effects</topic><topic>Diagnostic systems</topic><topic>Female</topic><topic>Graft Survival</topic><topic>Health aspects</topic><topic>Health risks</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Liver</topic><topic>Liver diseases</topic><topic>Liver transplantation</topic><topic>Liver Transplantation - methods</topic><topic>Liver Transplantation - mortality</topic><topic>Liver transplants</topic><topic>Male</topic><topic>Medicine and Health Sciences</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Organ transplantation</topic><topic>Outcome and process assessment (Medical care)</topic><topic>Patients</topic><topic>Postoperative complications</topic><topic>Predictions</topic><topic>Prognosis</topic><topic>Rank tests</topic><topic>Risk</topic><topic>Romania</topic><topic>Subgroups</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><topic>Survival</topic><topic>Survival Analysis</topic><topic>Tissue Donors</topic><topic>Transplantation</topic><topic>Transplants & implants</topic><topic>Treatment 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different clinical scoring systems in the assessment of short- and long-term outcome following orthotopic liver transplantation</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-03-21</date><risdate>2019</risdate><volume>14</volume><issue>3</issue><spage>e0214221</spage><epage>e0214221</epage><pages>e0214221-e0214221</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>In an attempt to further improve liver allograft utilization and outcome in orthotopic liver transplantation (OLT), a variety of clinical scoring systems have been developed. Here we aimed to comparatively investigate the association of the Balance-of-Risk (BAR), Survival-Outcomes-Following-Liver-Transplant (SOFT), Preallocation-Survival-Outcomes-Following-Liver-Transplant (pSOFT), Donor-Risk-Index (DRI), and the Eurotransplant-Donor-Risk-Index (ET-DRI) scores with short- and long-term outcome following OLT.
We included 338 consecutive patients, who underwent OLT in our institution between May 2010 and November 2017. For each prognostic model, the optimal cutoff values were determined with the help of the Youden-index and their diagnostic accuracy for 90-day post OLT-mortality and major postoperative complications was measured by the area under the receiver operating characteristic curve (AUROC). Patient- and graft survival were analyzed using the Kaplan-Meier method and the log-rank test. Morbidity was assessed using the Clavien-Dindo classification and the Comprehensive-Complication-Index.
BAR, SOFT, and pSOFT performed well above the conventional AUROC-threshold of 0.70 with good prediction of early mortality. Only BAR showed AUC>0.70 for both mortality and major morbidity. With the cutoffs of 14, 31, and 22 respectively for BAR, SOFT, and pSOFT, subgroup analysis showed significant differences (p<0.001) in morbidity and mortality, length of intensive care- and hospital-stay and early allograft dysfunction rates. Five-years patient survival was inferior in the high BAR, pSOFT, and SOFT groups.
Out of all scores tested, the BAR-score had the best value in predicting both 90-day morbidity and mortality after OLT showing the highest AUCs. The pSOFT and SOFT scores demonstrated an acceptable accuracy in predicting 90-day morbidity and mortality. The used BAR, SOFT, and pSOFT cutoffs allowed the identification of patients at risk in terms of five-year patient survival. The DRI and ET-DRI scores have failed to predict recipient outcomes in the present setting.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>30897167</pmid><doi>10.1371/journal.pone.0214221</doi><orcidid>https://orcid.org/0000-0003-0373-3210</orcidid><orcidid>https://orcid.org/0000-0001-9674-0756</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2019-03, Vol.14 (3), p.e0214221-e0214221 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2195910796 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Aged Allografts Analysis Blood products Complications Complications and side effects Diagnostic systems Female Graft Survival Health aspects Health risks Hospitals Humans Liver Liver diseases Liver transplantation Liver Transplantation - methods Liver Transplantation - mortality Liver transplants Male Medicine and Health Sciences Middle Aged Morbidity Mortality Organ transplantation Outcome and process assessment (Medical care) Patients Postoperative complications Predictions Prognosis Rank tests Risk Romania Subgroups Surgeons Surgery Surgical outcomes Survival Survival Analysis Tissue Donors Transplantation Transplants & implants Treatment Outcome |
| title | Potential value and limitations of different clinical scoring systems in the assessment of short- and long-term outcome following orthotopic liver transplantation |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-21T17%3A12%3A28IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Potential%20value%20and%20limitations%20of%20different%20clinical%20scoring%20systems%20in%20the%20assessment%20of%20short-%20and%20long-term%20outcome%20following%20orthotopic%20liver%20transplantation&rft.jtitle=PloS%20one&rft.au=Boecker,%20Joerg&rft.date=2019-03-21&rft.volume=14&rft.issue=3&rft.spage=e0214221&rft.epage=e0214221&rft.pages=e0214221-e0214221&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0214221&rft_dat=%3Cgale_plos_%3EA579651349%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2195910796&rft_id=info:pmid/30897167&rft_galeid=A579651349&rft_doaj_id=oai_doaj_org_article_f1eb1931564a4f22897056824ce46547&rfr_iscdi=true |