Meta-Analysis
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2018; 6(15): 995-1006
Published online Dec 6, 2018. doi: 10.12998/wjcc.v6.i15.995
Scoring systems for prediction of mortality in decompensated liver cirrhosis: A meta-analysis of test accuracy
Shi-Lan Wu, Yi-Xiang Zheng, Zheng-Wen Tian, Meng-Shi Chen, Hong-Zhuan Tan
Shi-Lan Wu, Zheng-Wen Tian, Meng-Shi Chen, Hong-Zhuan Tan, Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410000, Hunan Province, China
Yi-Xiang Zheng, Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha 410000, Hunan Province, China
Author contributions: Wu SL contributed to the study inception and design, literature search and selection, data acquisition, and analysis and writing of the manuscript; Zheng YX contributed to the study inception, literature selection, and data analysis and discussion; Tian ZW contributed to the literature search and selection, language editing, and manuscript revision; Chen MS contributed to the quality assessment and manuscript revision; Tan HZ contributed to the study design, manuscript revision, and study supervision; all authors approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hong-Zhuan Tan, PhD, Professor, Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410000, Hunan Province, China. tanhz99@qq.com
Telephone: +86-731-88858435 Fax: +86-731-84805454
Received: September 14, 2018
Peer-review started: September 14, 2018
First decision: November 1, 2018
Revised: November 8, 2018
Accepted: November 14, 2018
Article in press: November 15, 2018
Published online: December 6, 2018
ARTICLE HIGHLIGHTS
Research background

Liver cirrhosis is a common chronic disease worldwide and decompensated cirrhosis is associated with a high risk of death. To find accurate prognostic scoring system not only could help clinicians to make better decisions but also has a wide significance in the context of organ allocation for decompensated cirrhosis patients.

Research motivation

There are so many scoring systems to predict the mortality of decompensated cirrhosis patients, while it is uncertain which scoring system is better. We performed a meta-analysis to compare the accuracy of four scoring systems: Child–Turcotte–Pugh (CTP), Model for End-stage Liver Disease score (MELD), MELD-Na, and MELD to Serum Sodium ratio (MESO) for predicting the mortality in decompensated liver cirrhosis. It is beneficial for confirming a high accuracy scoring system to use in clinical practice.

Research objectives

The main objective is to quantitatively compare the test accuracy of scoring systems and to pinpoint the more reliable scoring systems to forecast the mortality of decompensated cirrhosis patients. It will help us to assess the state of an illness and make better decision.

Research methods

We searched PubMed, Web of science, Cochrane Library, EMBASE, and Ovid databases from inception to September 2018 for relevant articles and evaluated the quality of original articles by the Quality Assessment of Diagnostic Accuracy Studies 2 scale. As for statistical heterogeneity, threshold effect and non-threshold effect were assessed by Spearman correlation and Cochrane’s Q test, respectively. And optimum model was chosen to estimate the accuracy like diagnostic odd ratios, area under the summary receiver operating characteristic curve (AUROC). We used Deek’s funnel plot asymmetry to assess potential publication bias. Stata 12.0, Meta-DiSc 1.4, and Review Manager 5.3 were tools to be used.

Research results

Sixteen eligible studies involving 2337 decompensated liver cirrhosis patients were included in this meta-analysis. The overall analysis showed MESO had promising value with highest AUROC in all assessed scoring systems. MELD-Na had the best performance for predicting mortality at various time points. MELD had a unique advantage for patients with variceal hemorrhage.

Research conclusions

The study confirmed the best model in predicting the mortality of the decompensated cirrhosis patients at different time points, and MELD or CTP is better for predicting short-term mortality in variceal hemorrhage patients. Additionally, the number of the included studies was relatively small, which restricted the detailed analysis for heterogeneity.

Research perspectives

Further research would focus on more sensitive indicators that could be added into the model for optimizing the original scoring system, and a new model should be proposed for prognosis prediction more accurately. In addition, multicenter and long-term studies with larger samples could answer the question more convincingly.