Predicting 1-year mortality among patients with decompensated cirrhosis: results of a multicentre evaluation of the Bristol Prognostic Score

Sarah Pauline Bowers, Kathleen Clare, Louise Hagerty, Kirsty McColl, Eva Smith, Alana Brown-Kerr, Asma Ahmed, Fiona Finlay, John F. Dillon, Stephen Barclay

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
57 Downloads (Pure)

Abstract

Objective: Chronic liver disease continues to be a significant cause of morbidity and mortality yet remains challenging to prognosticate. This has been one of the barriers to implementing palliative care, particularly at an early stage. The Bristol Prognostic Score (BPS) was developed to identify patients with life expectancy less than 12 months and to act as a trigger for referral to palliative care services. This study retrospectively evaluated the BPS in a cohort of patients admitted to three Scottish hospitals.

Method: Routinely collated healthcare data were used to obtain demographics, BPS and analyse 1-year mortality for patients with decompensated liver disease admitted to three gastroenterology units over two 90-day periods. Statistical analysis was undertaken to assess performance of BPS in predicting mortality.

Results: 276 patients were included in the final analysis. Participants tended to be late middle-aged men, socioeconomically deprived and have alcohol-related liver disease. A similar proportion was BPS+ve (>3) in this study compared with the original Bristol cohort though had more hospital admissions, higher ongoing alcohol use and poorer performance status. BPS performed poorer in this non-Bristol group with sensitivity 54.9% (72.2% in original study), specificity 58% (83.8%) and positive predictive value (PPV) 43.4% (81.3%).

Conclusion: BPS was unable to accurately predict mortality in this Scottish cohort. This highlights the ongoing challenge of prognostication in patients with chronic liver disease, furthering the call for more work in this field.

Original languageEnglish
Article numbere000822
Number of pages6
JournalBMJ Open Gastroenterology
Volume9
Issue number1
Early online date22 Mar 2022
DOIs
Publication statusPublished - 22 Mar 2022

Keywords

  • chronic liver disease
  • liver
  • liver cirrhosis

ASJC Scopus subject areas

  • Gastroenterology

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