LIRER score – a valuable tool to predict medium-long-term outcomes in hepatic cirrhosis decompensation

Abstract

Background

The liver-renal-risk (LIRER) score was developed to predict adverse outcomes in cirrhotic patients with Model for End-stage Liver Disease (MELD)<18, helping the allocation to liver transplantation in this population. We aimed to assess its prognostic performance compared to other prognostic scores in first admission for hepatic cirrhosis decompensation.

Methods

Retrospective study that included patients admitted for initial decompensation of cirrhosis between January 2010 and February 2017. The LIRER, Child-Pugh (CP), MELD and MELD-sodium (MELD-Na) scores were calculated at admission.

Results

One-hundred and forty-six patients were included, 65.1% with MELD < 18. LIRER was a predictor of in-stay (AUC 0.70; p = .04), first-year (0.70; p < .001), two-years (0.72; p < .001) and overall mortality (0.70; p < .001), being the only score with an acceptable discriminating ability (AUC ≥ 0.70). Stratifying patients in MELD < 18 and ≥18, LIRER was found to be an independent predictor of first-year, two-years and overall-mortality only in MELD < 18 patients (AUC 0.67; 0.70; 0.72), being superior to all other scores predicting first-year mortality and the only with an AUC with a reasonable discriminating ability for predicting two-years and overall-mortality. The LIRER was also a predictor of 30-days hospital readmission (AUC 0.75; p < .001), independently of MELD, with patients with LIRER > 15.9 having a significantly higher probability to be readmitted at 30 days.

Conclusions

The LIRER score is a predictor of first-year, two-years and overall-mortality in decompensated cirrhosis, particularly in patients with MELD < 18. LIRER is therefore an important tool to predict medium-long-term outcomes in this population. Besides, it allows predicting the 30-days readmission probability in overall patients, independently of MELD.

Keywords:

• Hepatic cirrhosis
• LIRER score
• Child-Pugh score
• MELD score
• MELD-Na score

Author contributions

Freitas M. and Magalhães J. designed the study, carried out data analysis and drafted the manuscript. Xavier S. participated in the design of the study. Freitas M. and Magalhães R. participated on the acquisition of data and performed the statistical analysis. Magalhães J. and Marinho C. critically revised the manuscript. Cotter J. critically revised and approved the final version of the manuscript.

Disclosure statement

The authors do not have any disclosures to report.