Prognostic models in end stage liver disease

Best Pract Res Clin Gastroenterol. 2023 Dec:67:101866. doi: 10.1016/j.bpg.2023.101866. Epub 2023 Aug 31.

Abstract

Cirrhosis is a major cause of death worldwide, and is associated with significant health care costs. Even if milestones have been recently reached in understanding and managing end-stage liver disease (ESLD), the disease course remains somewhat difficult to prognosticate. These difficulties have already been acknowledged already in the past, when scores instead of single parameters have been proposed as valuable tools for short-term prognosis. These standard scores, like Child Turcotte Pugh (CTP) and model for end-stage liver disease (MELD) score, relying on biochemical and clinical parameters, are still widely used in clinical practice to predict short- and medium-term prognosis. The MELD score, which remains an accurate, easy-to-use, objective predictive score, has received significant modifications over time, in order to improve its performance especially in the liver transplant (LT) setting, where it is widely used as prioritization tool. Although many attempts to improve prognostic accuracy have failed because of lack of replicability or poor benefit with the comparator (often the MELD score or its variants), few scores have been recently proposed and validated especially for subgroups of patients with ESLD, as those with acute-on-chronic liver failure. Artificial intelligence will probably help hepatologists in the near future to fill the current gaps in predicting disease course and long-term prognosis of such patients.

Keywords: Acute-on-chronic liver failure; Allocation; Artificial intelligence; Liver transplantation.

Publication types

  • Review

MeSH terms

  • Artificial Intelligence
  • Child
  • Disease Progression
  • End Stage Liver Disease* / diagnosis
  • End Stage Liver Disease* / surgery
  • Humans
  • Liver Cirrhosis / diagnosis
  • Liver Cirrhosis / therapy
  • Prognosis
  • Retrospective Studies
  • Severity of Illness Index