A Karnofsky performance status–based score predicts death after hospital discharge in patients with cirrhosis

North American Consortium for the Study of End-Stage Liver Disease

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Identification of patients with cirrhosis at risk for death within 3 months of discharge from the hospital is essential to individualize postdischarge plans. The objective of the study was to identify an easy-to-use prognostic model based on the Karnofsky Performance Status (KPS). The North American Consortium for the Study of End-Stage Liver Disease consists of 16 tertiary-care hepatology centers that prospectively enroll nonelectively admitted cirrhosis patients. Patients enrolled had KPS assessed 1 week postdischarge. KPS was categorized into low (score 10-40), intermediate (50-70), and high (80-100). Of 954 middle-aged patients (57 ± 10 years, 63% men) with a median Model for End-Stage Liver Disease (MELD) score of 17 (interquartile range 13-21), the mortality rates for the low, intermediate, and high performance status groups were 23% (36/159), 11% (55/489), and 5% (15/306), respectively. Low, intermediate, and high performance status was seen in 17%, 51%, and 32% of the cohort, respectively. Low performance status was associated with older age, dialysis, hepatic encephalopathy, longer length of stay, and higher white blood cell count or MELD score at discharge. A model was derived using the three independent predictors of 3-month mortality: KPS, age, and MELD score. This score had better discrimination (area under the receiver operating characteristic curve = 0.74) than a model using MELD (area under the receiver operating characteristic curve = 0.62) or MELD and age (area under the receiver operating characteristic curve = 0.67) to predict 3-month mortality. Conclusions: Cirrhosis patients at risk for 3-month postdischarge mortality can be identified using a novel KPS-based score; this score may be adopted in practice to guide postdischarge early interventions, including the integrated provision of active and palliative management strategies. (Hepatology 2017;65:217-224).

Original languageEnglish (US)
Pages (from-to)217-224
Number of pages8
JournalHepatology
Volume65
Issue number1
DOIs
StatePublished - Jan 1 2017

Fingerprint

End Stage Liver Disease
Patient Discharge
Karnofsky Performance Status
Fibrosis
ROC Curve
Mortality
Gastroenterology
Hepatic Encephalopathy
Leukocyte Count
Tertiary Care Centers
Dialysis
Length of Stay

ASJC Scopus subject areas

  • Hepatology

Cite this

A Karnofsky performance status–based score predicts death after hospital discharge in patients with cirrhosis. / North American Consortium for the Study of End-Stage Liver Disease.

In: Hepatology, Vol. 65, No. 1, 01.01.2017, p. 217-224.

Research output: Contribution to journalArticle

North American Consortium for the Study of End-Stage Liver Disease 2017, 'A Karnofsky performance status–based score predicts death after hospital discharge in patients with cirrhosis', Hepatology, vol. 65, no. 1, pp. 217-224. https://doi.org/10.1002/hep.28900
North American Consortium for the Study of End-Stage Liver Disease. / A Karnofsky performance status–based score predicts death after hospital discharge in patients with cirrhosis. In: Hepatology. 2017 ; Vol. 65, No. 1. pp. 217-224.
@article{da1c5b3b360147ab9dcd7376f6f19eb1,
title = "A Karnofsky performance status–based score predicts death after hospital discharge in patients with cirrhosis",
abstract = "Identification of patients with cirrhosis at risk for death within 3 months of discharge from the hospital is essential to individualize postdischarge plans. The objective of the study was to identify an easy-to-use prognostic model based on the Karnofsky Performance Status (KPS). The North American Consortium for the Study of End-Stage Liver Disease consists of 16 tertiary-care hepatology centers that prospectively enroll nonelectively admitted cirrhosis patients. Patients enrolled had KPS assessed 1 week postdischarge. KPS was categorized into low (score 10-40), intermediate (50-70), and high (80-100). Of 954 middle-aged patients (57 ± 10 years, 63{\%} men) with a median Model for End-Stage Liver Disease (MELD) score of 17 (interquartile range 13-21), the mortality rates for the low, intermediate, and high performance status groups were 23{\%} (36/159), 11{\%} (55/489), and 5{\%} (15/306), respectively. Low, intermediate, and high performance status was seen in 17{\%}, 51{\%}, and 32{\%} of the cohort, respectively. Low performance status was associated with older age, dialysis, hepatic encephalopathy, longer length of stay, and higher white blood cell count or MELD score at discharge. A model was derived using the three independent predictors of 3-month mortality: KPS, age, and MELD score. This score had better discrimination (area under the receiver operating characteristic curve = 0.74) than a model using MELD (area under the receiver operating characteristic curve = 0.62) or MELD and age (area under the receiver operating characteristic curve = 0.67) to predict 3-month mortality. Conclusions: Cirrhosis patients at risk for 3-month postdischarge mortality can be identified using a novel KPS-based score; this score may be adopted in practice to guide postdischarge early interventions, including the integrated provision of active and palliative management strategies. (Hepatology 2017;65:217-224).",
author = "{North American Consortium for the Study of End-Stage Liver Disease} and Puneeta Tandon and Reddy, {K. Rajender} and O'Leary, {Jacqueline G.} and Guadalupe Garcia-Tsao and Abraldes, {Juan G.} and Florence Wong and Biggins, {Scott W.} and Benedict Maliakkal and Fallon, {Michael B.} and Subramanian, {Ram M.} and Paul Thuluvath and Kamath, {Patrick S.} and Thacker, {Leroy R.} and Bajaj, {Jasmohan S.}",
year = "2017",
month = "1",
day = "1",
doi = "10.1002/hep.28900",
language = "English (US)",
volume = "65",
pages = "217--224",
journal = "Hepatology",
issn = "0270-9139",
publisher = "John Wiley and Sons Ltd",
number = "1",

}

TY - JOUR

T1 - A Karnofsky performance status–based score predicts death after hospital discharge in patients with cirrhosis

AU - North American Consortium for the Study of End-Stage Liver Disease

AU - Tandon, Puneeta

AU - Reddy, K. Rajender

AU - O'Leary, Jacqueline G.

AU - Garcia-Tsao, Guadalupe

AU - Abraldes, Juan G.

AU - Wong, Florence

AU - Biggins, Scott W.

AU - Maliakkal, Benedict

AU - Fallon, Michael B.

AU - Subramanian, Ram M.

AU - Thuluvath, Paul

AU - Kamath, Patrick S.

AU - Thacker, Leroy R.

AU - Bajaj, Jasmohan S.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Identification of patients with cirrhosis at risk for death within 3 months of discharge from the hospital is essential to individualize postdischarge plans. The objective of the study was to identify an easy-to-use prognostic model based on the Karnofsky Performance Status (KPS). The North American Consortium for the Study of End-Stage Liver Disease consists of 16 tertiary-care hepatology centers that prospectively enroll nonelectively admitted cirrhosis patients. Patients enrolled had KPS assessed 1 week postdischarge. KPS was categorized into low (score 10-40), intermediate (50-70), and high (80-100). Of 954 middle-aged patients (57 ± 10 years, 63% men) with a median Model for End-Stage Liver Disease (MELD) score of 17 (interquartile range 13-21), the mortality rates for the low, intermediate, and high performance status groups were 23% (36/159), 11% (55/489), and 5% (15/306), respectively. Low, intermediate, and high performance status was seen in 17%, 51%, and 32% of the cohort, respectively. Low performance status was associated with older age, dialysis, hepatic encephalopathy, longer length of stay, and higher white blood cell count or MELD score at discharge. A model was derived using the three independent predictors of 3-month mortality: KPS, age, and MELD score. This score had better discrimination (area under the receiver operating characteristic curve = 0.74) than a model using MELD (area under the receiver operating characteristic curve = 0.62) or MELD and age (area under the receiver operating characteristic curve = 0.67) to predict 3-month mortality. Conclusions: Cirrhosis patients at risk for 3-month postdischarge mortality can be identified using a novel KPS-based score; this score may be adopted in practice to guide postdischarge early interventions, including the integrated provision of active and palliative management strategies. (Hepatology 2017;65:217-224).

AB - Identification of patients with cirrhosis at risk for death within 3 months of discharge from the hospital is essential to individualize postdischarge plans. The objective of the study was to identify an easy-to-use prognostic model based on the Karnofsky Performance Status (KPS). The North American Consortium for the Study of End-Stage Liver Disease consists of 16 tertiary-care hepatology centers that prospectively enroll nonelectively admitted cirrhosis patients. Patients enrolled had KPS assessed 1 week postdischarge. KPS was categorized into low (score 10-40), intermediate (50-70), and high (80-100). Of 954 middle-aged patients (57 ± 10 years, 63% men) with a median Model for End-Stage Liver Disease (MELD) score of 17 (interquartile range 13-21), the mortality rates for the low, intermediate, and high performance status groups were 23% (36/159), 11% (55/489), and 5% (15/306), respectively. Low, intermediate, and high performance status was seen in 17%, 51%, and 32% of the cohort, respectively. Low performance status was associated with older age, dialysis, hepatic encephalopathy, longer length of stay, and higher white blood cell count or MELD score at discharge. A model was derived using the three independent predictors of 3-month mortality: KPS, age, and MELD score. This score had better discrimination (area under the receiver operating characteristic curve = 0.74) than a model using MELD (area under the receiver operating characteristic curve = 0.62) or MELD and age (area under the receiver operating characteristic curve = 0.67) to predict 3-month mortality. Conclusions: Cirrhosis patients at risk for 3-month postdischarge mortality can be identified using a novel KPS-based score; this score may be adopted in practice to guide postdischarge early interventions, including the integrated provision of active and palliative management strategies. (Hepatology 2017;65:217-224).

UR - http://www.scopus.com/inward/record.url?scp=85007154538&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85007154538&partnerID=8YFLogxK

U2 - 10.1002/hep.28900

DO - 10.1002/hep.28900

M3 - Article

C2 - 27775842

AN - SCOPUS:85007154538

VL - 65

SP - 217

EP - 224

JO - Hepatology

JF - Hepatology

SN - 0270-9139

IS - 1

ER -