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Thématique :
- Foie
Originalité :
Réexamen
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2017/01  
 
  2017 Jan;65(1):217-224.  
  doi: 10.1002/hep.28900  
 
  A Karnofsky performance status-based score predicts death after hospital discharge in patients with cirrhosis.  
 
  Tandon P, Reddy KR, O'Leary JG, Garcia-Tsao G, Abraldes JG, Wong F, Biggins SW, Maliakkal B, Fallon MB, Subramanian RM, Thuluvath P, Kamath PS, Thacker LR, Bajaj JS; North American Consortium for the Study of End-Stage Liver Disease  
  https://www.ncbi.nlm.nih.gov/pubmed/27775842  
 
 

Abstract

Identification of patients with cirrhosis at risk for death within 3 months of discharge from the hospital is essential to individualize postdischarge plans. The objective of the study was to identify an easy-to-use prognostic model based on the Karnofsky Performance Status (KPS). The North American Consortium for the Study of End-Stage Liver Disease consists of 16 tertiary-care hepatology centers that prospectively enroll nonelectively admitted cirrhosis patients. Patients enrolled had KPS assessed 1 week postdischarge. KPS was categorized into low (score 10-40), intermediate (50-70), and high (80-100). Of 954 middle-aged patients (57 ± 10 years, 63% men) with a median Model for End-Stage Liver Disease (MELD) score of 17 (interquartile range 13-21), the mortality rates for the low, intermediate, and high performance status groups were 23% (36/159), 11% (55/489), and 5% (15/306), respectively. Low, intermediate, and high performance status was seen in 17%, 51%, and 32% of the cohort, respectively. Low performance status was associated with older age, dialysis, hepatic encephalopathy, longer length of stay, and higher white blood cell count or MELD score at discharge. A model was derived using the three independent predictors of 3-month mortality: KPS, age, and MELD score. This score had better discrimination (area under the receiver operating characteristic curve = 0.74) than a model using MELD (area under the receiver operating characteristic curve = 0.62) or MELD and age (area under the receiver operating characteristic curve = 0.67) to predict 3-month mortality.

CONCLUSIONS:

Cirrhosis patients at risk for 3-month postdischarge mortality can be identified using a novel KPS-based score; this score may be adopted in practice to guide postdischarge early interventions, including the integrated provision of active and palliative management strategies.

 

 
Question posée
 
Peut-on identifier les patients cirrhotiques à risque de décès dans les 3 mois suivant la sortie de l’hospitalisation à partir d’un outil pronostique simple basé sur le Karnofsky Performance Status (KPS)?
 
Question posée
 
Un KPS bas (score 10-40), est associé à un âge plus avancé, dialyse, encéphalopathie, durée de séjour plus longue, hyperleucocytose, MELD à la sortie et le taux de mortalité est de 23%. Un modèle a été dérivé en utilisant les prédicteurs de mortalité à 3 mois: KPS, âge, et score MELD.
 
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