Discordance in categorization of acute-on-chronic liver failure in the United Network for Organ Sharing database.
Discordance in categorization of acute-on-chronic liver failure in the United Network for Organ Sharing database.
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联合器官共享数据库网络中急性智力肝衰竭的分类不一致。
DOI：
10.1016/j.jhep.2021.12.040
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发表时间：
2022-05
影响因子：
25.7
通讯作者：
Mahmud, Nadim
中科院分区：
文献类型：
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作者：
Lee, Brian P.;Cullaro, Giuseppe;Vosooghi, Aidan;Yao, Frederick;Panchal, Sarjukumar;Goldberg, David S.;Terrault, Norah A.;Mahmud, Nadim
来自器官共享联合网络(UNOS)数据库的肝移植(LT)候选患者中有关慢性急性肝衰竭(ACLF)的研究正被用于向世界各地的肝移植政策变化提供信息。我们评估了在UNOS中识别ACLF的有效性。我们在2013-2019年间在3个美国肝移植中心进行了分层随机抽样，以获得不同ACLF级别的具有代表性的患者样本。根据EASL-CLIF标准，我们比较了UNOS分类与手工图盲法分类的一致性。根据UNOS分类，在481名抽样的LT注册者中，250名(52%)没有ACLF，75名(16%)ACLF为1级，79名(16%)ACLF为2级，77名(16%)ACLF为3级。UNOS评分与量表评分的符合率分别为72%、%、56%、%，总体Cohen‘s kappa系数为0.48(95%可信区间为0.42~0.54)。没有急性失代偿是高估的最常见原因，脑和呼吸衰竭分类不一致是UNOS低估ACLF的最常见原因。在这项多中心的回溯性研究中，UNOS对ACLF的分类与手工表检查结果的一致性较差。这些调查结果为正在进行的分配政策讨论提供了资料，突出了在LT进行关于ACLF的前瞻性研究的重要性，并应鼓励联合国操作系统的改革。急性慢性肝功能衰竭(ACLF)是一种特殊而常见的肝功能衰竭，病死率高。已经发表了使用美国移植登记(UNOS)来识别和描述患有ACLF的移植候选者和接受者的结果的研究，这些数据正在推动世界各地移植分配政策的变化，但没有人表明这些数据是否可靠。我们发现，与图表审查相比，联合国内罗毕办事处对ACLF的分类不一致或不准确，这表明联合国内罗毕办事处的改革和非UNOS研究需要适当地为与ACLF移植的政策提供信息。
Studies regarding acute-on-chronic liver failure (ACLF) among liver transplant (LT) candidates from the United Network for Organ Sharing (UNOS) database are being used to inform LT policy changes worldwide. We assessed the validity of identifying ACLF in UNOS. We performed stratified random sampling among 3 US LT centers between 2013–2019 to obtain a representative patient sample across ACLF grades. We compared the concordance of ACLF classification by UNOS vs. blinded manual chart review, according to EASL-CLIF. Among 481 sampled LT registrants, 250 (52%) had no ACLF, 75 (16%) had ACLF grade 1, 79 (16%) had ACLF Grade 2, and 77 (16%) had ACLF Grade 3 per UNOS categorization. Concordance of ACLF grade by UNOS vs. chart review was: 72%, 64%, 56%, and 64% for no ACLF, Grade 1, Grade 2, and Grade 3, respectively, with overall Cohen’s kappa coefficient 0.48 (95%CI 0.42–0.54). Absence of acute decompensation was the most common reason for overestimation, and discordant brain and respiratory failure categorization were the most common reasons for underestimation of ACLF by UNOS. In this retrospective multi-center study, ACLF categorization by UNOS showed weak agreement with manual chart review. These findings are informative for ongoing allocation policy discussions, highlight the importance of prospective studies regarding ACLF in LT and should encourage UNOS reform. Acute-on-chronic-liver-failure (ACLF) is a specific and common form of liver failure with high death rates. Studies have been published using the United States transplant registry (UNOS) to identify and describe outcomes of transplant candidates and recipients with ACLF, and these data are driving policy changes for transplant allocation around the world, but nobody has shown whether these data are reliable. We found that UNOS was not categorizing ACLF in concordance or accurately when compared to chart review, which shows the need for UNOS reform and non-UNOS studies to appropriately inform policies in transplant with ACLF.
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DOI：
10.1016/j.jhepr.2020.100176
发表时间：
2021-03
期刊：
JHEP reports : innovation in hepatology
影响因子：
--
作者：
Zaccherini G;Weiss E;Moreau R
通讯作者：
Moreau R
影响因子：
7.2
作者：
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通讯作者：
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影响因子：
29.4
作者：
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通讯作者：
Arroyo, Vicente
影响因子：
29.4
作者：
Sundaram, Vinay;Jalan, Rajiv;Wong, Robert J.
通讯作者：
Wong, Robert J.
影响因子：
25.7
作者：
Hernaez, Ruben;Liu, Yan;Kramer, Jennifer R.;Rana, Abbas;El-Serag, Hashem B.;Kanwal, Fasiha
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Kanwal, Fasiha