Meta-analysis of performance of Kings's College Hospital Criteria in prediction of outcome in non-paracetamol-induced acute liver failure
Meta-analysis of performance of Kings's College Hospital Criteria in prediction of outcome in non-paracetamol-induced acute liver failure
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DOI：
10.1016/j.jhep.2010.03.023
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发表时间：
2010-09-01
影响因子：
25.7
通讯作者：
Bernal, William
中科院分区：
文献类型：
--
作者：
McPhail, Mark J. W.;Wendon, Julia A.;Bernal, William
背景和目标：尽管国王学院标准 (KCC) 是最常用的工具，但目前预测急性肝衰竭 (ALF) 紧急肝移植 (ELT) 的结果和需求的技术尚不完善。他们在识别非扑热息痛诱发的 ALF（非 POD ALF）患者方面的表现最近受到质疑，这些患者如果没有 ELT 就无法生存。因此，我们使用定量技术对 KCC 结果数据进行荟萃分析，以预测非 POD ALF 的生存率。方法：进行系统数据库搜索并检索根据预先商定的方法学质量形式分级的文章。对整理后的数据进行荟萃分析，以总结敏感性、特异性、诊断比值比 (DOR) 和 ROC 曲线分析。根据方法学质量、报告患者肝性脑病 (HE) 的严重程度、KCC 应用时机以及排除接受 ELT 的患者进行预先指定的亚组分析。结果：包含 1105 名患者数据的 18 项研究可用于制作 2 x 2 表格。总体敏感性为 68 (95% Cl 59-77)%，特异性为 82 (75-88)%，DOR 12.6 (6.5-26.1)。在 DOR 中检测到异质性，且与方法学质量相关（所有研究的 I-2 = 64%，“良好”质量研究的异质性为 47%），并且在考虑高级别 HE 或动态应用 KCC 的研究中异质性较低（I-2 = 0%）。对于排除 ELT 的数据（13 项研究），汇总敏感性为 68 (5779)%，特异性为 81 (72-90)%，DOR 12.2 (4.9-30.1)，并生成对称汇总 ROC 曲线。在针对高级别 HE 患者的研究中特异性最高 (93 (80-100)%)，并且在整个临床过程中动态应用 KCC (88 (78-97)%)。与 1995 年之前的研究相比，2005 年之后发表的研究的敏感性有所降低（58 (46-71)% 对比 85 (76-82)%）。结论：KCC 对非 POD ALF 结局具有良好的特异性和更有限的敏感性。已发表的数据存在显着的异质性，部分与方法学质量有关。 KCC 在患有高度脑病的群体中表现最佳，历史上早期的研究表明 ALF 的现代医疗管理可能会改变 KCC 的表现。 (C) 2010 年由 Elsevier B.V. 代表欧洲肝脏研究协会出版。
Background & Aims: Current techniques for predicting outcome and requirement for emergency liver transplantation (ELT) in acute liver failure (ALF) are imperfect, though The Kings College Criteria (KCC) are the most commonly applied tools for this purpose. Their performance in identification of patients with non-paracetamol-induced ALF (non-POD ALF), who would not survive without ELT, has recently been questioned. Using quantitative techniques, we therefore performed a meta-analysis of outcome data of the KCC for prediction of survival in non-POD ALF.Methods: A systematic database search was performed and retrieved articles graded according to a pre-agreed pro-forma of methodological quality. Collated data was meta-analysed for summary sensitivity, specificity, diagnostic odds ratio (DOR) and ROC curve analysis. Pre-specified sub-group analysis was performed on the basis of methodological quality, the severity of hepatic encephalopathy (HE) of reported patients, timing of KCC application and exclusion of those who underwent ELT.Results: Eighteen studies with data on 1105 patients were available for production of 2 x 2 tables. Summary sensitivity was 68 (95% Cl 59-77)%, specificity 82 (75-88)% and DOR 12.6 (6.5-26.1). Heterogeneity was detected in the DOR and related to methodological quality (I-2 = 64% for all studies versus 47% for 'good' quality studies) and was lower in studies considering high grade HE or dynamic application of KCC (I-2 = 0%). For data where ELT were excluded (13 studies) summary sensitivity was 68 (5779)%, specificity 81 (72-90)% and DOR 12.2 (4.9-30.1) and a symmetric summary ROC curve was produced. Specificity was highest in studies of patients with high grade HE (93 (80-100)%) and where KCC were applied dynamically through the clinical course (88 (78-97)%). Sensitivity was reduced in studies published post 2005 compared with studies pre 1995 (58 (46-71)% versus 85 (76-82)%).Conclusions: KCC for outcome in non-POD ALF have good specificity and more limited sensitivity. There is significant heterogeneity in the published data partially related to methodological quality. KCC perform best in groups with high grade encephalopathy and in historically earlier studies suggesting modern medical management of ALF may modify performance of KCC. (C) 2010 Published by Elsevier B.V. on behalf of the European Association for the Study of the Liver.