Evidence map›Paper›PMID 32938387›Full record

ArticleBMC gastroenterology2020

Extra-hepatic comorbidity burden significantly increases 90-day mortality in patients with cirrhosis and high model for endstage liver disease.

Scott Coppel, Karan Mathur, Burcin Ekser, Kavish R Patidar, Eric Orman, Archita P Desai, Eduardo Vilar-Gomez, Chandrashekhar Kubal, Naga Chalasani, Lauren Nephew and 1 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC gastroenterology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
0.6field-weighted citation impact, top 31% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 13 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 2 institutions in 1 country.

Scott CoppelMedicine, Indiana University, Indianapolis, IN, USA.
Karan MathurGastroenterology and Hepatology, Indiana University, 702 Rotary Circle, suite 225, Indianapolis, IN, 46202, USA.
Burcin EkserTransplant Surgery, Indiana University, Indianapolis, IN, USA.
Kavish R PatidarGastroenterology and Hepatology, Indiana University, 702 Rotary Circle, suite 225, Indianapolis, IN, 46202, USA.
Eric OrmanGastroenterology and Hepatology, Indiana University, 702 Rotary Circle, suite 225, Indianapolis, IN, 46202, USA.
Archita P DesaiGastroenterology and Hepatology, Indiana University, 702 Rotary Circle, suite 225, Indianapolis, IN, 46202, USA.
Eduardo Vilar-GomezGastroenterology and Hepatology, Indiana University, 702 Rotary Circle, suite 225, Indianapolis, IN, 46202, USA.
Chandrashekhar KubalTransplant Surgery, Indiana University, Indianapolis, IN, USA.
Naga ChalasaniGastroenterology and Hepatology, Indiana University, 702 Rotary Circle, suite 225, Indianapolis, IN, 46202, USA.
Lauren NephewGastroenterology and Hepatology, Indiana University, 702 Rotary Circle, suite 225, Indianapolis, IN, 46202, USA.
Marwan GhabrilGastroenterology and Hepatology, Indiana University, 702 Rotary Circle, suite 225, Indianapolis, IN, 46202, USA. mghabril@iu.edu.ORCID http://orcid.org/0000-0002-4784-3246
Indiana University – Purdue University Indianapolis · USIndiana University Health · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundWe examined how extra-hepatic comorbidity burden impacts mortality in patients with cirrhosis referred for liver transplantation (LT).

methodsAdults with cirrhosis evaluated for their first LT in 2012 were followed through their clinical course with last follow up in 2019. Extra-hepatic comorbidity burden was measured using the Charlson Comorbidity Index (CCI). The endpoints were 90-day transplant free survival (Cox-Proportional Hazard regression), and overall mortality (competing risk analysis).

resultsThe study included 340 patients, mean age 56 ± 11, 63% male and MELD-Na 17.2 ± 6.6. The CCI was 0 (no comorbidities) in 44%, 1-2 in 44% and > 2 (highest decile) in 12%, with no differences based on gender but higher CCI in patients with fatty and cryptogenic liver disease. Thirty-three (10%) of 332 patients not receiving LT within 90 days died. Beyond MELD-Na, the CCI was independently associated with 90-day mortality (hazard ratio (HR), 1.32 (95% confidence interval (CI) 1.02-1.72). Ninety-day mortality was specifically increased with higher CCI category and MELD ≥18 (12% (CCI = 0), 22% (CCI = 1-2) and 33% (CCI > 2), (p = 0.002)) but not MELD-Na ≤17. At last follow-up, 69 patients were alive, 100 underwent LT and 171 died without LT. CCI was associated with increased overall mortality in the competing risk analysis (Sub-HR 1.24, 95%CI 1.1-1.4).

conclusionsExtra-hepatic comorbidity burden significantly impacts short-term mortality in patients with cirrhosis and high MELD-Na. This has implications in determining urgency of LT and mortality models in cirrhosis and LT waitlisting, especially with an ageing population with increasing prevalence of fatty liver disease.

Indexed as

Liver DiseasesLiver TransplantationAdultAgedComorbidityFemaleHumansLiver CirrhosisMaleMiddle AgedProportional Hazards ModelsSodiumSodiumCharlson comorbidity indexCirrhosisComorbidityLiver transplantationMortality

Identifiers

PMID32938387
PMCPMC7493147
OpenAlexW3087714040

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.