Original articleSystematic reviews and meta-analysesAbility of King's College Criteria and Model for End-Stage Liver Disease Scores to Predict Mortality of Patients With Acute Liver Failure: A Meta-analysis
Section snippets
Search Methodology
We conducted a systematic review of the literature by searching MEDLINE via PUBMED, Scopus, Web of Science, CINAHL and EMBASE for articles that reported on the diagnostic accuracy of KCC and MELD for ALF published between January 1, 2001 (because 2001 was the year that MELD was first validated as a predictor of outcome in chronic liver disease) and May 1, 2015. The search terms used were “Acute liver failure” OR “Fulminant liver failure,” “King’s Criteria” OR “King’s College Criteria” OR “Kings
Results
The search strategy identified 4063 potentially relevant studies. After screening their title and abstract, 311 were retrieved and evaluated. A further 9 studies were identified from the references of the articles evaluated and also reviewed. A total of 23 studies were found with enough information to go forward into a meta-analysis (Figure 1).19, 20, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54 The eligible studies evaluated a total of 2153 patients. KCC
Discussion
This meta-analysis confirms that when comparing KCC with MELD for outcome prediction in ALF, KCC have lower sensitivity and MELD lower specificity. However, the overall diagnostic accuracy of KCC and MELD in determining outcome as measured by DOR and sROC is comparable. The particular strength of the KCC seems to be in AALF where the DOR is twice that of MELD.
There is significant heterogeneity in the published studies for the performance of both prediction schemes but particularly for MELD,
Acknowledgments
Mark McPhail is grateful to the National Institute for Health Research, UK Biomedical Research Centre at Imperial College London for infrastructure support.
References (56)
- et al.
Acute liver failure
Lancet
(2010) Liver transplantation for acute liver failure
Best Pract Res Clin Gastroenterol
(2012)- et al.
Early indicators of prognosis in fulminant hepatic failure
Gastroenterology
(1989) - et al.
Use and validation of selection criteria for liver transplantation in acute liver failure
Liver Transpl
(2000) - et al.
Acute liver failure: clinical features, outcome analysis, and applicability of prognostic criteria
Liver Transpl
(2000) - et al.
Emergency liver transplantation for acute liver failure. Evaluation of London and Clichy criteria
J Hepatol
(1993) - et al.
Early indicators of prognosis in fulminant hepatic failure: an assessment of the King's criteria
J Hepatol
(1997) Acute liver failure in the United States
Semin Liver Dis
(2003)- et al.
A model to predict survival in patients with end-stage liver disease
Hepatology
(2001) - et al.
Model for end-stage liver disease (MELD) and allocation of donor livers
Gastroenterology
(2003)
Prothrombin time to assess fulminant hepatic failure
Lancet
Meta-analysis of performance of Kings's College Hospital Criteria in prediction of outcome in non-paracetamol-induced acute liver failure
J Hepatol
The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed
J Clin Epidemiol
Utility of the MAYO End-Stage Liver Disease score, King's College Criteria, and a new in-hospital mortality score in the prognosis of in-hospital mortality in acute liver failure
Transplant Proc
MELD score as a prognostic model for listing acute liver failure patients for liver transplantation
Transplant Proc
Prognostic implications of lactate, bilirubin, and etiology in German patients with acute liver failure
Clin Gastroenterol Hepatol
Cytokeratin 18-based modification of the MELD score improves prediction of spontaneous survival after acute liver injury
J Hepatol
Etiologies and outcomes of acute liver failure in Germany
Clin Gastroenterol Hepatol
Indocyanine green clearance test combined with MELD score in predicting the short-term prognosis of patients with acute liver failure
Hepatobiliary Pancreat Dis Int
Acute liver failure
N Engl J Med
Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States
Ann Intern Med
Intensive care management of acute liver failure
Semin Liver Dis
The role of transjugular liver biopsy in fulminant liver failure: relation to other prognostic indicators
Hepatology
Fulminant hepatic failure secondary to acetaminophen poisoning: a systematic review and meta-analysis of prognostic criteria determining the need for liver transplantation
Crit Care Med
A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts
Hepatology
MELD score as a predictor of pretransplant and posttransplant survival in OPTN/UNOS status 1 patients
Hepatology
Performance of MELD in predicting outcome in acute liver failure
Gastroenterology
Fulminant hepatitis A virus infection in the United States: incidence, prognosis, and outcomes
Hepatology
Cited by (0)
This article has an accompanying continuing medical education activity on page e44. Learning Objective–Upon completion of this activity, successful learners should be able to understand and explain the statistical terms commonly used in evaluating prognostic tests and in meta-analysis studies; compare the advantages and disadvantages of King's College Criteria and model for end-stage liver disease in acute liver failure prognosticating; differentiate when a high specificity or high sensitivity test is more important when deciding on the need for emergency liver transplantation; and be able to describe the potential sources of bias for performance of King's College Criteria and model for end-stage liver disease and how these can be quantified statistically.
Conflicts of interest The authors disclose no conflicts.
Funding Mark McPhail was supported by the Wellcome Trust, UK as part of a Postdoctoral Training Fellowship during the production of this article.
- a
These authors contributed equally to this article.